Radiology Coding Alert

Question: When a non-radiologist performs a procedure such as fluoroscopy that uses both radiology staff and equipment resources, I know that I should only charge the technical component portion of the procedure. For example, I would charge fluoroscopy (76000-TC) and retrograde urography (74420-TC) if the radiologist did not actually do the procedure. We assume that the non-radiologist physician will document the fluoroscopy in his operative report and will thus get paid for the professional component. But what about spot films that are presented to the radiologist for interpretation after the procedure? Should I charge a routine exam technical component of the appropriate anatomy with a -52 modifier (Reduced services) and an unmodified professional component?

West Virginia Subscriber

Answer: The professional services rendered should always be charged by the CPT code that accurately describes the interpretive services provided. To improve the quality of care, as well as simplify the coding and billing of these professional services, radiology experts recommend that you establish imaging protocols for these types of films. For example, if fluoroscopic imaging is provided for a non-radiologist physician without the radiologist in attendance, then you are correct in noting that the accurate code for the fluoro-scopic services would be submitted by the facility or practice with modifier -TC (Technical component).

If hard-copy imaging is performed, and the imaging will be interpreted by the radiologist, then you should establish a protocol for the correct imaging (e.g., plain film of the abdomen, lateral film of the lumbar spine, chest radiograph) appropriate for the study in question. The plain films or films with contrast, as appropriate would then be interpreted by the radiologist, and the bill would be submitted with modifier -26 for the professional component. However, please note that radiological quality-assurance services are not separately billed to the insurer but should be paid directly by the hospital to the radiologist. There must be a medically necessary interpretation.

The technical component of these films may or may not need to be separately billed in addition to the fluoroscopy dependent on the nature of the fluoroscopic -TC service already billed. For example, let's take the case of the radiological supervision and interpretation (RS&I) codes for endoscopic retrograde cholangiopancreatography (ERCP). The RS&I codes e.g., 74320 (Cholan-giography, percutaneous, transhepatic, RS&I) include the technical component of the plain films. Therefore, the technical component of these films would not be separately billed in addition to the ERCP S&I code.