Radiology Coding Alert
Read Over This Over-Read Question
New Jersey Subscriber
Answer: You have two options for reporting these services - neither of which involves reporting an E/M code for a confirmatory consultation.
Option 1: Your best option is to report radiology code 76140 (Consultation on x-ray examination made elsewhere, written report). You can't report the same code that the radiologist reported for the initial reading of the CT or MRI because that would be considered double-billing if the initial study was performed by the same practice. Plus, many payers will only allow the entity that originally provided the service to report the original CT or MRI code.
Warning: Most payers do not assign any RVUs (relative value units) or APCs to 76140, so don't be surprised if you are not reimbursed when reporting this code. The "second opinion" service is generally charged to the entity requesting the second interpretation, such as the other medical practice.
If you want to ensure payment, consider having the patient sign an advance beneficiary notice letting the patient know that Medicare may deny coverage and that he will be responsible for costs in that case.
Option 2: Another option for reporting these "over-reads" is to consult your insurance payer about its preferred method of coding this service. Some coders report having insurers that require them to use the CPT code for that initial taking of the films, append modifier -26 (Professional component), and indicate in the report that this is a second read. Always obtain payer guidance in writing.
Caveat: The mammogram example you cite is a little trickier, and you will need to check with your payer before submitting a claim for this service. Although 76140 is technically correct in this situation, many carriers prefer that you instead code for the exam itself: 76091 (Mammography; bilateral). You will save yourself time in appeals if you ask carriers in advance how they want you to report these second opinions.
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