Radiology Coding Alert

Question: I code for a family practice and need to know how to bill x-rays read by our doctors. If a code specifies two views, but the doctor only does one view, should I bill the two-view code with modifier -52 (Reduced services)? Does it qualify as an interpretation if the doctor just states the results of the x-ray in his regular notes? 

Nebraska Subscriber

Answer: Yes and no, in that order. You are right to use modifier -52 in the example you provided, but make sure your physician has provided an x-ray interpretation that is distinguishable from his visit results.
 If you are sure that there is no other code for "one view," you must add modifier -52 to report reduced services. The American College of Radiology provides general documentation guidelines at the Web site www.acr.org/dyna/?doc=departments/stand_accred/standards/standards.html.
 
By the way, because your practice owns the x-ray machine, you don't have to append modifier -26 (Professional component), and you can receive the global fee for the service. To answer your question on the doctor's interpretation, he must provide a separately identifiable interpretation of the x-ray, similar to what a radiologist would do. This interpretation needs to be distinguishable from the visit results, but it does not have to be on a separate piece of paper.
 
 - The answers for You Be the Coder and Reader Questions were reviewed by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga.; and Gary S. Dorfman, MD, FACR, FSIR.