Wiki comparison x-rays

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dmaec

dmaec

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sorry guys, I'm drawing a blank on this and can't find one website that addresses the topic!

Can we charge/bill for an x-ray taken solely for comparison reasons?

(I know silly question)

Some say yes, but add a 52 modifier - I don't think the comparison justifies the use of the .52 mod.

others say flat out NO..can't do it.

others say yes.

all info, opinions, sources welcomed!! :)

thanks TONS!
 
I'll take a stab, Donna~

Personally, I don't think you should bill for comparison views. My answer leans more towards medical necessity. Payment guidelines are so driven by carrier edits and policies...I just see this as one more hurdle to jump over. I see modifier 52 used more for xrays that are inherently bilateral and for whatever reason, only one side was perfomed. Now...if someone has something from the AMA stating otherwise...please share.
 
thanks for the response Rebecca! I too was leaning towards "no, we don't code/bill for it" in fact that's what I told patient accounting... that is untill I found this "guideline",...this is from a work comp carrier (and no, this patient isn't a work comp case) however, their explanation as to when and why they would cover it, makes sense. So, I told pt acct to hold it for a bit till I get some more feed back, check into more, find some resouces!

2. Comparison X-Rays:
Comparison x-rays would be considered reasonable if there is, on initial radiographic examination of the affected area, a finding which may or may not represent a variation of normal. The observed finding for which comparison views are deemed necessary must be well described in the initial report and given as a reason for obtaining comparison x-rays.

Actually, the reason they did the comparison on this patient was the fact that they saw something (or possibly nothing) on the x-ray of the injured arm,..coudn't really say what it was for certain so the doctor ordered another x-ray of the other elbow for comparison.

I don't think comparisons are done very often, I know the insurance company didn't pay for this one (that's the reason we're reviewing it)..

I still can't find a thing about this online!
thanks for your input - VERY MUCH APPRECIATED! :)
 
Let us know what you find out. I see carriers really "zooming in" on these records to determine if there is a conflict of interest or "financial gain". I know, for the most part, providers would order a comparison view if there was only a true need (and may be reimbursed on a case by case review) but I could also see this being potentially abused by some.
 
What diagnosis code would you use on the comparison?

We never bill for them but that's just our practice's policy.

Diane Huston, CPC,RCC
 
Comparison

If the medical necessity is there to substantiate billing for it I code V72.5. There's nothing else I have found that fits.
 
THANK YOU ALL FOR RESPONDING :)
we've decided (well the "powers that be" decided) that we just will not be billing out comparisons.

documentation supports it, indeed...but the decision for the facility is that they will not be billed.

(I still can't get over how there just isn't anything out there on the web that addresses this issue more in depth)

thanks again to all! :)
 
some states require that children under certain ages have comparison x-rays . in the urgent care setting in PA it is required to be performed on children
 
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