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X-ray interpretation with modifier -26

Gina Posted Tue 25th of October, 2016 12:20:45 PM
We have several patients that bring in x-ray films, reports, etc and when billed with the x-ray code and modifier -26, payers deny the service as included in the payment for other services. Is this covered? Do we need to have ordered the x-rays or can they be ordered by an outside provider in order to bill this with modifier 26?
SuperCoder Answered Wed 26th of October, 2016 01:24:26 AM

When a patient presents to a provider for a new or established patient visit or for a consultation visit and brings his/her medical records, including x-rays or other imaging studies, only the proper E/M or consultation service is reported.

Review of radiology or imagine studies films and reports are considered a portion of the E/M service. E/M codes include work done before, during or after the E/M visit.

But if no E/M service was provided and provider only performed some procedure and review the radiology or imagine study films and reports, then they can bill the service with professional componet (-26 modifier).

 

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