Radiology Coding Alert

Question: Our radiologist interpreted the results of a fistulogram and wrote a report for the interpretation. We can’t find a CPT^® code for the service. What can we report?

Codify Subscriber

Answer: Although CPT^® doesn’t include a code for the interpretation alone, you can describe your situation using modifiers on code 76080 (Radiologic examination, abscess, fistula or sinus tract study, radiological supervision and interpretation). The question will be, which modifier should you report?

“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. “In situations in which a cardiologist, for example, bills for the supervision (the ‘S’) of the S&I code, and a radiologist bills for the interpretation (the ‘I’) of the code, both physicians should use a 52 modifier indicating a reduced service, e.g., only one of supervision and/or interpretation…Payment for the fragmented S&I code is no more than if a single physician furnished both aspects of the procedure.”

Although that’s what Medicare says, some payers may prefer that you append modifier 26 (Professional component) instead of (or in addition to) modifier 52 (Reduced services). This demonstrates that your physician performed the professional component of the code (the interpretation) while the other doctor performed the actual fistulogram procedure. That physician will append modifier TC (Technical component) to 76080 and you’ll append modifier 26 and/or 52, depending on which your payer prefers.