Wiki ER Physician Billing Diagnostics

Create Wiki
M

Miax0328

Guest
Messages
7
Best answers
0
I have recently run across a situation where the ER doctor is not only billing a E/M code, but also the x-ray codes with modifier 26. However, I'm also receiving bills from the radiologists billing for the same DOS and same x-ray code with the modifier 26. The notes 9/10 list the radiologist's name. Our system sees these as duplicates. My question is, can a ER doctor bill for the x-ray or should those charges be included in the E/M code or should we process them as adjustments?

Note: The OP hospital bills the diagnostic, which is considered the TC and is paid for without a problem.
 
Is your ER doctor dictating a report for the x-rays?

There is no reason the ER doctor couldn't bill for the reading if they are doing it and dictating a report. The question is, if that is what is happening why is a radiologist then coming in and reading as well?

My personal experience with ER and urgent care was the physicians looked at the x-rays but did not dictate reports and therefore did not charge for the readings. The radiologist came in and did the official read and report and billed for it.

There appears to be some overlap in the process or misunderstanding of who is or should be doing what.

Good luck,

Laura, CPC, CEMC
 
My bet is the ER physician is billing inaccurately. I would pend the claim and request a copy of the radiology report from the ER physician AND the radiologist and decide from there. If you look at the notes in CPT at the beginning of the radiology section there is a section titled "Written reports". "A written report signed by the interpreting physician should be an integral part of a radiological procedure or interpretation". This one has been a war between the two sides for quite some time, but realistically on a claims payment basis, only one of them gets paid for professional component.
 
Thanks for the quick response. Per the ER and diagnostic notes, its listing the radiologists name on the diagnostic reports, I haven't been seeing the ER doctor as even reading the x-rays.

Just a side note, I'm not doing the coding, I'm on the other end receiving and processing these bills from the ER doctor, radiologists, etc.
 
the treating physician is giving a wet reading which is not reimbursable. -26 means the physician interpreting the diagnostic reading writes a report as well. NO REPORT, NO -26.
hope this helps

Miax0328 said:
I have recently run across a situation where the ER doctor is not only billing a E/M code, but also the x-ray codes with modifier 26. However, I'm also receiving bills from the radiologists billing for the same DOS and same x-ray code with the modifier 26. The notes 9/10 list the radiologist's name. Our system sees these as duplicates. My question is, can a ER doctor bill for the x-ray or should those charges be included in the E/M code or should we process them as adjustments?

Note: The OP hospital bills the diagnostic, which is considered the TC and is paid for without a problem.
Click to expand...
 
You must log in or register to reply here.
Top