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Modifier

Robert Posted Wed 09th of March, 2011 22:07:43 PM

What is the correct modifier to put with a chest x-ray? Is it necessary?

SuperCoder Answered Thu 10th of March, 2011 05:41:55 AM

Modifier -59, -76, TC, -26, etc. would be used according to documentation.
Following is an example of the proper use of modifier -59:

A patient has a chest X-ray (code 71020) at 10 a.m. A second chest X-ray (code 71010) is taken at 3 p.m. The -59 modifier should be added to code 71010 to indicate the X-rays were done at separate times. This is a different session or patient encounter.

When radiologists interpret two x-rays on the same day that require the same code, proper use of modifier 76 (Repeat procedure or service by same physician) should be used.

Scenario: A physician performs two chest x-rays (71010, Radiologic examination, chest; single view, frontal) on a patient with chest pain. The same radiologist interprets both films.
Solution: When repeating the x-ray is medically necessary, you should report the first service as usual and append modifier 76 to the second. Note that if you’re reporting only the interpretation, you should append modifier 26 (Professional component), as well.
Example: You report:
• 71010-26
• 71010-26-76.

A chest x-ray (71020, Radiologic examination, chest; 2 views, frontal and lateral) includes both technical and professional components. If you’re reporting only the technical component, report 71020 and append modifier TC (Technical component); if you’re reporting only the professional component (performing the test only), append modifier 26 (Professional component) instead. If you’re coding for both the test and its reading, simply report 71020 with no modifiers.

Robert Posted Mon 20th of June, 2011 18:56:44 PM

What if it was only one x-ray taken on the same day/same time as an office visit. We have a machine in our office so dr. can do them here and interpret them. I billed;

99214
71020 25

This is being denied saying "procedure code is inconsistent with modifier used or a required modifier is missing? I don't know how to bill this.

SuperCoder Answered Mon 20th of June, 2011 19:23:16 PM

Normally, Chest X-ray is read by the Radiologist. In E/M cases, even if the physician evaluated chest x-ray as part of the visit, then there will be two different claims, one for the E/M and another for the chest x-ray.
The E/M level may have become higher for interpretation of chest as it is 99214 in this case.

While billing chest x-ray, the code should be 71010-26

Colleen Answered Tue 21st of June, 2011 14:06:20 PM

We have the same situation as Dr. Bader and we bill the 99214 and the 71010 without any modifiers. If he is doing both technical and interpretation and owns the equipment why would he need the modifier on the xray?

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