Wiki Diagnostic Radiology

[Kat M]

I have two separate reports on the same DOS, ordered by two different providers on the same day. One is Ct Abdomen/Pelvis WO Contrast, and the other is CT abdomen/Pelvis With Contrast. This would clearly be an unbundling issue if billed this way, so I have elected to replace the four separate charges to two charges for CT Ab/Pel W&WO contrast. My problem is that there are two orders involved, written by two different physicians. I don't know which should be on the dictated report as the referring provider. Can anyone shed a little light on this situation? Thanks!

 

[AuntJoyce]

Hi Kat~ I coded Radiology (Diagnostic and Interventional) for a couple of years. When we had situations such as this one, we had to determine first if the studies were done in the same session or separate sessions. If they were done in the same session (regardless of the fact that there were 2 separate orders from 2 separate sources), you combine them just as you did. However, if the non-contrast study was done and the patient was brought back to Radiology at a later time on the same day (separate session), you would code them separate and apart from one another. It's been about 3 years since I did code Radiology and so I can't remember if a modifier -77 is appropriate (repeat procedure by another physician) simply because they are not quite the same procedure. I hope this sheds at least a little light on the matter. Have a great day!
Joyce

 

[AuntJoyce]

Kat...sorry, I forgot to mention (or ask) if it was the same Radiologist reading both studies. If it was the same Radiologist, then consideration for -76 modifier should be entertained. I did check with a former co-worker (who is currently coding Radiology) and have been told that they indeed bill the non-contrast study separate from the contrast study if they are done in separate sessions and especially if there are two distinct readings/reports issued.

Sorry if I confused the matter.

Joyce

 

[jgf-CPC]

Kat,
We would call the physician's office and explain what happened and let them know that the insur company would probably not pay for all 4 procedures and ask them if they would not mind that the procedures be combined to the w and w/o with just one of the referring physician's name on it and that we would make sure the other physician received a report. Or else depending upon the insur company, bill it all with an explanation of what happened.