Radiology Coding Alert

Question: If we perform a diagnostic X-ray for a Medicare patient at our office and the patient then undergoes inpatient surgery, are we required to append modifier PD?

Georgia Subscriber

Answer: If you're coding for a physician practice that is wholly owned or operated by a hospital, and the patient is admitted to that hospital within three days, you should append modifier PD (Diagnostic or related nondiagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days) to the codes for any diagnostic or related non-diagnostic services you provided. You must apply the modifier to relevant services as of July 1, 2012.

Practices self-designate whether they're owned or operated by a hospital during Medicare enrollment. The hospital is responsible for alerting you if the patient is admitted.

Tip: If you report a code that has both professional and technical components, modifier PD will trigger Medicare to pay for only the professional component. The technical component will be considered a hospital cost. If you append PD to a code that doesn't have both professional and technical components, Medicare will pay for the service based on the facility rate (rather than the non-facility rate).

Resource: You can learn more about modifier PD use at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM7502.pdf. CMS posted FAQs on the payment window, including which hospital types are subject to a one-day window, at http://cms.hhs.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Downloads/CR7502-FAQ.pdf.