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PROFESSIONAL FEE ONLY

Leigh Posted Tue 06th of May, 2014 10:52:39 AM

If in an office setting, where we normally bill globally, a CT Chest, Abdomen, & Pelvis is done and read-- but then those same images are reconstructed in order to read a CT Lumbar--- can we bill the professional fee for the CT Lumbar?

I understand we can't bill Global or Technical because we didn't do another scan, but instead read reconstructed images.

Thanks

SuperCoder Answered Wed 07th of May, 2014 06:55:06 AM

You can report the physician's portion, but the facility charge might be a little bit stickier.

For the physician's professional service, the Spring 2006 issue of the AMA's Clinical Examples in Radiology says that you can appropriately report the spine CT code when the radiologist does a full and complete spine interpretation.

The article notes, -If a full and complete spine interpretation is requested subsequently from reconstructed data (e.g., from the trauma series performed for abdomen evaluation), it is appropriate to code for the additional professional services by reporting the appropriate 70000 series CT CPT code(s) appended by modifier 26.-

The problem is the facility charge. -Everyone agrees that it is not appropriate for the facility to receive full payment for two CT scans when there was only one image acquisition. However, that's about as far as the agreement goes.-

The American Hospital Association's Third Quarter 2006 Coding Clinic for HCPCS states, -Although the images were reconstructed to show images of the lumbar spine, an additional code for the reconstructed image of the lumbar spine is not required since this did not require a rescanning of the patient.-

Therefore, some payers may follow that advice and not reimburse the facility for the spine exam, while others might be more flexible.

It's reasonable for the hospital to want some reimbursement for the work involved in the spine exam -Clinical Examples in Radiology recommends the use of modifier 52 (Reduced services) on the technical component charge, and is a reasonable solution.-

Providers should watch their payer policies closely because some carriers are just discovering this quandary and may soon be writing up and implementing guidelines about it.

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