Wiki TC modifier and x-rays

[ccade315]

I am wanting input on a on-going discussion with our coding department.

I have just been told by our office manager not to add the TC modifier to X-rays that are done in the PCP office. let me explaine that the office ownes the x-ray machine, even though the PCP will read the X-Ray, it is always sent to a radiologist to read as well. So I am adding the TC modifier to the x-ray, but as I have stated, our manager has told me this is wrong. I do not agree with this. By not adding the TC, I consider this double dipping because we are getting paid for both parts. What is going to happen when the radiologist tries to send their bill in for reading the same x-ray?

Please let me know what your thoughts are, and where I can get some documentation to support my point of view.

Thank you.

 

[mitchellde]

If you are sending the X-ray out for an official interpretation then you are correct, your provider can bill only the TC portion. It sounds like your provider is performing just an over read which you include in thenE&M under MDM.

 

[MarcusM]

Your PCP could get paid for his "interpretation" if he dictates a separate report from the radiologist's report. Your PCP would need to document his differing opinion of the interpretation from the radiologist's opinions. Ex: Radiologist does not find a fracture but PCP thinks there is a fracture because of ...... But if your PCP just looks at the films and notes a normal view of whatever body part is being x-rayed, this is just part of the E&M like Debra noted above.