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Radiology Reading Fees/CPT Code

Kimberley Posted Fri 09th of May, 2014 10:48:33 AM

We perform in office Ultrasounds and bill the patient's insurance. We pay the Ultrasound technician & the Radiologist as independent contractors. Is there a separate CPT code to bill for Radiologist fee?

SuperCoder Answered Mon 12th of May, 2014 12:26:10 PM

If the physician took the ultrasound, but did not read it, a TC modifier would need to be appended to the code. Similarly, a modifier 26 would be used with the global CPT code if the doctor read the ultrsound but did not take it. The physician may only report the professional interpretation (modifier 26) if the ultrasound has not already been interpreted.

Kimberley Posted Tue 20th of May, 2014 14:37:16 PM

I am still a little unclear. We have been billing the ultrasound code. We then pay for a Radiologist to read these images and generate a report. The Radiologist does NOT bill the insurance company for reading the ultrasound. We pay him directly for these services. Is there a way for us to bill the insurance company for the reading of the ultrasounds?

SuperCoder Answered Fri 23rd of May, 2014 15:20:17 PM

It sounds to me like you are performing the entire (global) ultrasound service, so you billing globally, which includes the tech portion of performing the ultrasound and the professional read of the ultrasound. Depending on how the facility/office is set up, you could bill the technical portion of the ultrasound with the TC and the radiologist read (prof componenent) with modifier 26…but you may have to bill globally and work out their contractual rates with the radiologists aside from coding reimbursement.

Kimberley Posted Sun 08th of June, 2014 18:37:36 PM

We are just billing 1 code for an Ultrasound. How do I confirm that it the global code?

Kimberley Posted Tue 17th of June, 2014 11:33:25 AM

I posted a week ago about confirming we are billing the global CPT, with no response. Please assist me with this clarification. I would like to see an example of billing 76801 globally and how to bill professional 7 technical portion separately to be sure I understand fully.

SuperCoder Answered Tue 17th of June, 2014 18:12:21 PM

I have read through the posting, and advise as follows:
" We have been billing the ultrasound code. We then pay for a Radiologist to read these images and generate a report. The Radiologist does NOT bill the insurance company for reading the ultrasound. We pay him directly for these services."

If the Radiologist is contracted by you, and your office is paying the Radiologist, you would will code the Ultrasound without modifiers. This is what is known as the global code, in other words your office is performing the ultrasound, interpreting the ultrasound as well as providing the written report (even though the Radiologist is contracted). Without the Radiologist billing separately and in order for you to get the maximum reimbursement, you would bill 76801 to be reimbursed for all the components of the ultrasound.

If you were not paying the radiologist, you would modify the code with a 26 or TC Modifier depending on which portion of the ultrasound your office is performing.

TC Modifier is for the use of the equipment used to perform the ultrasound and the technician performing the ultrasound

26 Modifier is used for the interpretation and report only for the service (ex the Radiologist reading the ultrasound and writing the report)

I hope this helps answer your question.

Thank you

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