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Family Practice Coding Alert

You Be the Coder:

Interpreting X-rays

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.   Question: Is it appropriate for our practice to bill for reading x-rays? Our family physician reads his own, but I recently read an article that seemed to disagree. It stated that the diagnostic interpretation of an x-ray with a written report by the radiologist is a covered service, but added that  on occasion the official interpretation may be made by a physician other than a radiologist. Does this mean that all x-rays must be overread by a radiologist?   Alaska Subscriber   Answer: Medicare policy indicates that family physicians (FPs) can interpret x-rays, if it falls within their scope of practice. Many FPs own x-ray equipment within their suite and routinely read the films.   Most coding experts say that Medicare s reference to scope of practice is included to ensure that an appropriately trained physician is reading a specific x-ray. For instance, it is not correct for a podiatrist to read a chest x-ray, or for a urologist to interpret an x-ray of a broken tibia. In most cases, an FP has been trained to read straightforward x-rays (i.e., skeletal films), and so may perform, code and bill them.   Generally speaking, a family physician will refer a patient to a radiologist for more complex conditions that demand greater expertise.   When reporting x-rays, coders can bill the CPT radiology code one of three ways: the code without a modifier if the FP took the x-rays and read them; the code with the -TC modifier (technical component) if the FP simply took the films, but had them read by a radiologist; and the code with modifier -26 (professional component) if the films were taken elsewhere (e.g., at the hospital) but read by the FP. For example, a practice might report 73600 (radiologic examination, ankle; two views) if they performed the global service, but would report 73600-TC for only taking the films and 73600-26 for only reading the films.

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