Our physicians (orthopedic surgeons) interpret their own x-rays. There is not a radiologist that reads or bills. For years we have billed the "professional component". However, we have several carriers that are now denying stating it's included in the E&M. The physician does not consider the interpretation portion in their MDM for determining the level to charge, as we are billing separately. There is also a separate interpretation report that is done. We do not own the radiology equipment so we do not whole procedure. Is anyone else experiencing this? Is there something different we should be doing as far as billing.
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Wiki Orthopedic Radiology Interpretations
- Thread starter TLORD
- Start date
ashlie09
New
We have had some denials come through of ours as well. We bill only the professional component because we rent office space and the x-ray equipment is not ours. The provider who owns the x-ray equipment bills for the technical component. I have done corrected claims and billed without the 26 modifier and been paid for some of them, as it appears there was an error in billing from the other office. If that still denies, then I have had to submit an appeal, and then we have gotten paid. I don't know if its just the payers arbitrarily denying a percentage in the hopes we are too lazy to actually appeal.... or something else. Following this thread.
amyjph
True Blue
Is the technical component being billed correctly? If another provider bills the x-ray and it's missing the TC and their claim gets in before you, that could be why. That is, if it is a "new" denial problem and you have only recently been seeing it. Do they maybe have a new biller or coder that is making errors?
Other than that, I would do a review to see exactly how many claims you are talking about, which specific carriers, and the time frame.
Depending on what is found there, you may have to look at the payer guidelines to see if they have an edit or a weird modifier they are looking for.
You may have to appeal them
christienrandy
New
Do you know if the interpretation still has to be in a separate report? We are wanting to include it in our office visit summary. Thank you!
marissaclemmer
New
Per the guidelines, it still requires a separate stand-alone report for the interpretation (26 modifier component).