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Will chest x-ray be paid separately when billed pediatric critical care same day

Arul karthik Posted Wed 09th of May, 2018 01:06:42 AM
Can you clarify whether we can bill chest x-ray which is done by Radiologist & Pediatric critical care (99471 -99476) which is done by Cardiologist on the same day. Will chest x-ray be paid separately?
SuperCoder Answered Fri 11th of May, 2018 04:08:18 AM

There can be two scenarios for the above documentation.

 

  1. If both the providers (radiologist and cardiologist) performed the chest x-ray within the critical care service time; then it would be considered inclusive. In this case, report only Paediatric critical care E/M code ONLY.
  2. If both the providers (radiologist and cardiologist) performed the chest x-ray outside the critical care service time; then you may report both the Paediatric critical care E/M code and chest x-ray.

 

Note: Both the providers should have a separate radiological report of the chest x-ray to get separate reimbursement on the billed date of service.

Also, append modifier-59 (on chest x-ray CPT code) to override the bundling conflict between the E/M code (Paediatric critical care) and chest x-ray procedure, when the chest x-ray was performed outside the critical care service time.

 

Kindly check your medical documentation for the above-mentioned scenarios before reporting.

 

Hope that helps!

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