Paula Posted Fri 25th of July, 2014 16:24:14 PM
family practice billing for xray read-can't get it paid. only getting paid for xray-like chest xray.
we are billing 76140 and it is coming back denied. why?
SuperCoder Answered Sat 26th of July, 2014 08:16:56 AM
Medicare and some private payers assign "0" relative value units (RVUs) to 76140 and will not reimburse you for this service. If your commercial insurer allows payment for this service, ask for the coverage guidelines in writing before billing 76140 to avoid unnecessary denials.
If you want to ensure payment, consider having a patient sign an advance beneficiary notice for Medicare (or similar waiver for private payers) letting the patient know that insurance may deny coverage and that the patient will be responsible for costs in that case.
Alternative: Some coders report that their insurers require them to use the imaging code for the actual exam, append modifier 26 (Professional component), and indicate in the report that it is a second read. Always obtain payer guidance in writing. Many payers will allow only the entity that originally provided the service to report the imaging code.
Remember: Code 76140 isn't appropriate if the over-reads are performed as part of a quality assurance program. Code 76140 also isn't appropriate when a radiologist reviews an older film simply to compare it to a current exam. "A comparison with old studies, when available, is an integral component of the interpretation of any study," CPT® Assistant (July 2007) states. As a result, you should not report the comparison service separately.
Hope it helps.