Urology Coding Alert

Question: Can a physician bill for reading CT scans in the office? Occasionally, a patient brings the disk to our office and the doctors read and evaluate the scans. Can I report a radiology code using modifier 26?

Illinois Subscriber

Answer: The physician may read the films, but in your case it appears that another physician, probably a radiologist, has already interpreted the study. You cannot charge for another reading as payers will usually pay for only one interpretation. You can, however, use your urologist's reading as part of his data review in the third key component -- the medical decision making (MDM) -- which may allow you to bill a higher level E/M service.

Alternative: If your urologist disagrees with a previous reading, you may then bill for another interpretation using modifiers 26 (Professional component) and 77 (Repeat procedure by another physician). You will need documentation and a cover letter explaining the circumstances if you hope to receive compensation for your interpretation. Be prepared, however, for the payer to stand firm and pay for only one interpretation.