Wiki Overreads

[tarafarmer]

In our office when a patient comes in for an xray, we do the xray and the doctor reads it. After our doctors have done and read the xray, we send them out for the radiologist to give a second reading. We have been billing the complete xray on the date of service then billing for the radiologist consult with a 26 modifier the next day. Carolina Care Plan is no longer wanting to pay this way. Does anyone out there have a contractual agreement with a radiologist to do second readings of the xrays performed in their offices? Are you getting paid for doing it that way? Has anyone used CPT 76140 for a similar situation?

 

[sbicknell]

Who's name would be in the final radiology report? That's who gets to code/bill for the -26 portion of the 70000 code. The Radiologist is not doing a "second read" he is doing the final interp and report.

Unless your physicians are also Radiologists, they can use the reviewing of the xray to build their MDM but they can not provide the required final interp/report. A radiologist is required to provide the final written interp.

I would suspect that if services were audited by the payer it would show duplicate charging and they would initiate a massive recoupment:
your Doc---coding and billing 70000 complete TC&26
Rad----coding and billing 70000-26

What should be happening is:
your Doc---coding and billing 70000-TC
Rad----coding and billing 70000-26

The only way you can continue to code the Complete TC&26 is if the practice and radiologist develop a contract for the Rad to provide these interp services for you and he is paid an agreed fee. This opens a can of worms so your Practice Admin and Physicians will have to look into their options

 

[eafaoro1]

radiology and practice agreement

If a practice had a contract agreement with an outside radiologist to read and perform a report for each x-ray, wouldn't the practice still bill out the rendering global service under the radiologist name not the ordering practice physicians name? The radiologist doesn't have to be an employee of the practice since they have a contract but wouldn't the radiologist have to be credentialed under the participating insurance carriers that the practice is under the practice's tax id? And articles or advise is needed!