I am receiving claims for Breast ultrasounds and MRI's for example with E&M codes attached. I was told that this is to cover the physicians work to find the lump or area being xrayed. At one coding seminar I had asked if this was appropriate. I was told this was an inclusive part of the radiology. Can anyone verify which way is appropriate?
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Wiki E&M codes with Radiology codes
- Thread starter allyssa.kittle@va.gov
- Start date
jgf-CPC
Guest
GaPeach77
Guru
The physician has to exam the patient first which the E/M codes cover. Radiology codes for ultrasounds and MRI's do not include RVU's for the actually examiniation. The E/M code should be modified with a 25 modifier. A physician cannot come to the decision that a patient needs a MRI/Ultrasound, etc without first examining the patient, therefore they should be reimbursed for both. Good Luck!
Simone
Simone
jgf-CPC
Guest
So they are not being referred to radiology with an order from a referring physician? The Dx given is from where they already had an E&M and a reason for the procedure. Even if our Rad Dr. sees the patient during the exam here and they order another procedure an E&M is not charged.
donnajrichmond
Guest
I agree with Jackie. If this is in a radiology department or imaging center, the radiologist generally will not bill for an E & M service.