Radiology Coding Alert

Question: A radiologist in our imaging facility interpreted the results of a patient’s elbow arthography for another physician. The radiologist wrote a report of their findings and submitted it to the requesting physician.

How do we report this service?

Nevada Subscriber

Answer: While the CPT^® code set doesn’t have codes dealing specifically with interpretation, you can accurately describe the radiologist’s service by appending 73085 (Radiologic examination, elbow, arthrography, radiological supervision and interpretation) with a modifier.

Ultimately, which modifier you assign will come down to your payer’s preferences. Some payers may prefer using modifier 26 (Professional Component) alongside or instead of modifier 52 (Reduced services). Modifier 26 shows the payer the radiologist performed the professional component of the code, or the interpretation, while another physician conducted the elbow arthography.

However, if your payer is Medicare or Medicaid, “The interpretation of the procedure may be performed later by another physician,” CMS says in section 13.80.1 of the Medicare Claims Processing Manual. The manual continues to instruct if a radiologist is billing for just the interpretation, they “should use a ‘-52’ modifier indicating a reduced service.”

For this scenario, the physician performing the procedure will append their 73085 with modifier TC (Technical component; …) while your report will feature modifier 52 and/or 26 depending on your payer’s preferences.