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Xray reviewed by outside source

Annette Posted Sat 17th of August, 2013 17:28:35 PM

Is there a code or modifier to use when films are reviewed from an outside source as a new patient?

SuperCoder Answered Mon 19th of August, 2013 19:56:32 PM

I’d like to clarify the exact scenario.

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, 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 the new patient E/M code.

If you’re coding for taking the x-ray without the formal interpretation, then report the x-ray code with modifier TC.

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