nperry@umc.edu
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I would be interested in knowing how your organization bills for Outside film interpretations. We have always billed CPT code 76140 and expected denials from Medicare. Some of our Radiologists went to a seminar and were advised that we should be billing for these under the regular CPT code of the area interpreted with an attached "26 & 77" modifiers. Our Compliance Dept has not allowed this in the past but now based on the below information states we should bill these as the regular original CPT codes. I would appreciate any feedback.
FAMILY PRACTICE MANAGMENT
Q. When we send X-ray films done in a family practice office to a radiologist for a second opinion after having billed the insurance for a global charge, what code should the radiologist use to be reimbursed?
A. Based on the information you’re provided, it seems the radiologist could use CPT code 76140, or in the case of a Medicare patient, use the code for the radiological exam with a -26 modifier attached. In either case, the presumption is that the X-ray consult is done independently of any E/M service provided to the patient by the radiologist.
FAMILY PRACTICE MANAGMENT
Q. When we send X-ray films done in a family practice office to a radiologist for a second opinion after having billed the insurance for a global charge, what code should the radiologist use to be reimbursed?
A. Based on the information you’re provided, it seems the radiologist could use CPT code 76140, or in the case of a Medicare patient, use the code for the radiological exam with a -26 modifier attached. In either case, the presumption is that the X-ray consult is done independently of any E/M service provided to the patient by the radiologist.
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