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MRI reading

Annette Posted Thu 10th of October, 2013 09:20:11 AM

Is there a code and/or modifier for an orthopedic to read an MRI from an outside source?

SuperCoder Answered Thu 10th of October, 2013 21:41:47 PM

If you’re coding for a physician who provides a formal review and report of images taken by a separate entity, then append modifier 26 to the x-ray code to indicate you’re reporting only the professional component. For Medicare, the POS is where the film was taken. If this is a second interpretation/report for this same set of images (i.e., a radiologist has already provided a formal report), payers may pay only the first claim sent in.

Or if an outside physician asks your physician to provide a second opinion on the images, then 76140 applies. Many payers won’t reimburse for this code, and some may have different preferences for how to report these over-read services.

Or if an outside group interprets and provides the report for the x-ray and sends the info to your MD who discusses the results (and their relation to treatment) with the patient, then this would be included in tallying an E/M code.

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