Radiology Coding Alert

Question: I’m new to emergency department (ED) coding, and I need your help with this patient encounter. A patient presented to the hospital ED with complaints of severe pelvic pain. The attending physician performed a physical examination and ordered a pelvic computed tomography (CT) scan without contrast for further diagnosis. The record also indicated that a radiologist who isn’t employed by the hospital performed the CT scan, interpreted the results, and wrote their report of the scan.

How should I report the CT scan? When would a radiologist not be a hospital employee, but able to perform radiology procedures?

New Mexico Subscriber

Answer: You’ll assign 72192 (Computed tomography, pelvis; without contrast material) appended with modifier 26 (Professional component) to report the CT scan of the patient’s pelvis without contrast. Modifier 26 is used here to show that the radiologist performed the interpretation and report of the procedure. The hospital most likely owns the CT equipment, which fulfills the procedure’s technical component.

The radiologist isn’t an employee of the hospital, and that isn’t an uncommon situation. Examples of situations when the radiologist isn’t a hospital employee, but can perform radiology procedures, include:

• Independent contractor: A radiologist could be an independent contractor who provides their services to multiple facilities in a large area. This can occur in areas where the demand for radiology services is high, but facilities don’t have enough radiologists on staff to meet the demand.
• Radiology group: A radiologist could be part of a radiology group that contracts with a local hospital to provide services. This situation is common in larger hospitals and medical centers where a group of radiologists provide services to the organization.
• Tele-radiology: A radiologist may not be physically in the hospital but can perform services remotely. This situation is useful in rural or remote areas where patients might have limited access to radiology services.