Wiki Guidelines for billing X-ray with E&M

Messages
20
Best answers
0
Good morning!!

I was hoping someone could help me with this. We just started billing X-rays in an office setting. These X-rays are done in office. In order for us to bill them, does a written report need to be in the account? And does the provider also need to reference to the xray report in his note? Just want to make sure we're doing this right.

Thank you
 
Good morning!!

I was hoping someone could help me with this. We just started billing X-rays in an office setting. These X-rays are done in office. In order for us to bill them, does a written report need to be in the account? And does the provider also need to reference to the xray report in his note? Just want to make sure we're doing this right.

Thank you
Assuming that your clinic owns the X-ray machine which is the most common, then you can bill X-rays. No need to use either -TC or -26 since your office will be providing both parts. There is no such thing as billing something that is not documented. You need to document that the X-rays were taken in your clinic on that DOS. The interpretation needs to be documented as well, even if there are no abnormalities. If someone brings in their own X-rays that needs to be documented as well so you don't bill for them.
 
Assuming that your clinic owns the X-ray machine which is the most common, then you can bill X-rays. No need to use either -TC or -26 since your office will be providing both parts. There is no such thing as billing something that is not documented. You need to document that the X-rays were taken in your clinic on that DOS. The interpretation needs to be documented as well, even if there are no abnormalities. If someone brings in their own X-rays that needs to be documented as well so you don't bill for them.
Thanks so much for your response! Do you know if there needs a separate written report of the interpretation? Or does the interpretation just need to be documented in the office note? Or both?
 
It seems you are talking about two different things. Your question is "Guidelines for billing X-ray with E&M" which is a little different from asking if a written report is required.
There are "usually" no conflicts between CPT for X-Rays (7xxxx) and office E&M (99211-99205) with regard to billing line items (like requiring a modifier).
However, if you are billing separately for the X-Ray, you can't also count it in the E&M level because that would be getting credit 2x. https://www.ama-assn.org/system/files/cpt-corrections-errata-2021.pdf

"Services Reported Separately Any specifically identifiable procedure or service (ie, identified with a specific CPT code) performed on the date of E/M services may be reported separately. The ordering and actual performance and/or interpretation of diagnostic tests/studies during a patient encounter are not included in determining the levels of E/M services when the professional interpretation of those tests/studies is reported separately by the physician or other qualified health care professional reporting the E/M service. Tests that do not require separate interpretation (eg, tests that are results only) and are analyzed as part of MDM do not count as an independent interpretation, but may be counted as ordered or reviewed for selecting an MDM level. Physician performance of diagnostic tests/studies for which specific CPT codes are available may be reported separately, in addition to the appropriate E/M code. The physician’s interpretation of the results of diagnostic tests/studies (ie, professional component) with preparation of a separate distinctly identifiable signed written report may also be reported separately, using the appropriate CPT code and, if required, with modifier 26 appended. If a test/study is independently interpreted in order to manage the patient as part of the E/M service, but is not separately reported, it is part of MDM.

You would want to consult and review the radiology billing guidelines and CPT descriptions regarding the required documentation for this. Written reports are required for billing the interpretation with specific parameters. They also require documentation or an order, among other things.
As Orthocoderpgu said, if your practice owns the equipment and it's done in office you wouldn't need to use a TC or 26 because you are billing the global X-Ray. However, there could be state rules and/or CMS rules if a PA or NPP is involved. You may want to check with your internal compliance department or practice manager, etc. This is bigger than just "hey, we started doing this let's bill them."

Old links but still relevant, you just need to keep in mind it's outdated. https://www.aaos.org/aaosnow/2007/janfeb/managing/managing1/ https://www.aapc.com/blog/26233-seven-tips-for-diagnostic-radiology-coding-success/

ACR site usually has info: https://www.acr.org/
 
Top