Radiology Coding Alert

Question: Should I report CT and MRI over-reads as consultations, or is there a specific code for these services?


Pennsylvania Subscriber

Answer: The term "over-read" can mean several different things, and your code selection depends on the specific meaning.

1. Consultation: An over-read can be a new interpretation of an existing study from another institution, requested by another physician. Example: An oncologist asks a radiologist to review and provide written comments on an MRI performed at another hospital. This type of over-read is a separately billable service.

2. Quality assurance: An over-read can be a review performed for quality assurance (QA) purposes. Example: One radiologist may review 10 exams performed by another radiologist at the same institution to ensure that the original interpretation was accurate. Payers consider QA reviews administrative services, and you cannot bill them as patient services.

3. Comparison: When a radiologist interprets a current imaging exam, he may also review prior exams to see if there has been any interim change. The prior exams may have been taken at the same facility or elsewhere. This review is part of the current interpretation, and you should not charge it separately.

According to CPT, the most accurate consultation over-read code is 76140 (Consultation on x-ray examination made elsewhere, written report). You can use this code only for over-reads that (a) are requested by another physician or other provider and (b) involve exams taken elsewhere. Don't report 76140 for an over-read of an exam taken at the same hospital.

Problem: CMS classifies 76140 as Status I (Not valid for Medicare purposes), assigns no relative value units to the code, and won't pay it.

Some coders report payers asking for the CPT code for the initial test (such as 71250, Computed tomography, thorax; without contrast material), whereas others want the initial test code with modifier 26 (Professional component) appended and a note that you're reporting a second read. But before using this billing method, you should make sure your carrier will accept it.

Bottom line: Save yourself the frustration of denials by asking your payer for its preference in writing.