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Chest x ray billing question

Linda Posted Wed 16th of November, 2011 17:06:30 PM

The family practice physician did a chest x ray in his office for chest pain. (he owns the equipment) This primary care provider alone made the deciscion to provide this chest x ray, there was not a referring doctor. Medicare denied this stating it needs a referring doctor. How does a primary care provider get reimbursed for a chest x ray when there isn't a referring doctor?

SuperCoder Answered Wed 16th of November, 2011 18:17:45 PM

If the PCP has the training, expertise and expectation to perform certain tests and procedures, then there is no need to issue a referral for their performance.
Ref: http://www.mcres.com/mcrmm05.htm
This type of denial often involves multiple problems associated with it which can cause a denial. Plz check if any other physician billed for chest x-ray on the same day.

Linda Posted Wed 16th of November, 2011 23:07:11 PM

No other provider billed for this chest x ray, only this primary care provider did and read the chest x ray in his office. I have received this denial before, medicare won't pay unless the patient was referred for this service.?! If this provider is a primary care provider, the patient wouldn't be referred by anyone. Again, what does medicare expect the primary care to put as a referring doctor if the patient not referred?

SuperCoder Answered Thu 17th of November, 2011 13:53:40 PM

I shared experience of a billing expert. In the box of referral, plz fill the name of the PCP and refile. Let me know the outcome in your case. As per his opinion, it will be paid.

Linda Posted Mon 28th of November, 2011 06:27:28 AM

Sanjit, Thanks I'll refile it with the PCPs name and will let you know what happens. Thanks

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