Wiki Basic xray question/help!!!

[tdavid]

I work with a family practice and the MD will be doing basic xrays soon...we hope. I am looking in to the coding portion of it and reimbursement. I see just for basic code 71010 (chest xray) that the reimbursement for Medicare is like $18 or less. Does that code include interpretation as well???? For what I understood the TC was if the provider read it only and the 26 was professional component only....SO VERY CONFUSED!!! Please help anyone.....

He is wondering also why the hospital can charge like $250 for a chest xray (I do understand there are multiple view etc) and only the reimbursement is this. Maybe I am missing a code for just interpretation?!?!?!

Thanks so much.

 

[donnajrichmond]

I work with a family practice and the MD will be doing basic xrays soon...we hope. I am looking in to the coding portion of it and reimbursement. I see just for basic code 71010 (chest xray) that the reimbursement for Medicare is like $18 or less. Does that code include interpretation as well???? For what I understood the TC was if the provider read it only and the 26 was professional component only....SO VERY CONFUSED!!! Please help anyone.....

He is wondering also why the hospital can charge like $250 for a chest xray (I do understand there are multiple view etc) and only the reimbursement is this. Maybe I am missing a code for just interpretation?!?!?!

Thanks so much.

TC is used if you only take the x-ray and don't interpret it. Modifier -26 is when you interpret the x-ray but it was taken elsewhere. If you are billing for both taking and interpreting the x-ray, then you bill the code without a modifier - the global service. If you look at the 70000 codes in the fee schedule, there should be 3 separate listings:
71010; 71010-TC; 71010-26.
- 26 = professional component =interpreting and providing a report
Make sure the interpretation is separately identifiable and similar to what a radiologist would provide. Just noting "x-ray normal" within the body of the visit documentation is not enough to bill for a separate x-ray charge.
-TC = technical component = taking the x-ray using your own equipment, tech, room, supplies, etc.
The global combines those, and the fee for global is equal to the technical component and professional component added.