Wiki help with workers comp claims for xrays

[EileenC]

ok, so if an urgent care does xrays and the er docs there intrepret and list finding in the progress note: when I send paper claim to worker comp- I send progress note, do I also need to send some type of "report" from the urgent care" of the xray or does the finding in the progress note stand as sufficient documentation of the xray for payment of the xray.

 

[mitchellde]

in order to bill for the global xray (no modifiers attached) then you must have the equipment, and the patient's chart must have a separately documented radiology interpretation report. A finding reported in the progress note is not sufficient for the professional component. Many times the ER doc is just providing a "wet" read and the film will be sent to a radiologist for a professional interp. The radiologist then will get the professional component, the ER doc includes his interp as a part of the E&M

 

[agiannino]

Yes, you must use the "26" (professional component) modifier with the ER doctors claim - this way when you send the notes of the interpretation you are showing that the doctor did not perform the xrays - only did the professional component piece.

 

[EileenC]

xray documentation

in order to bill for the global xray (no modifiers attached) then you must have the equipment, and the patient's chart must have a separately documented radiology interpretation report. A finding reported in the progress note is not sufficient for the professional component. Many times the ER doc is just providing a "wet" read and the film will be sent to a radiologist for a professional interp. The radiologist then will get the professional component, the ER doc includes his interp as a part of the E&M

Thanks, this is a help and exactly what I thought, but I needed it in writing from another source.