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CPT codes, descriptors and other data only are copyright 1999
American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply.
Radiology
1. Can radiologists provide interpretation of a radiology film(s) as a second opinion when requested by another physician? (Last Reviewed: July 16, 2008)
2. Is a separate order from the physician required when x-rays are taken intraoperatively? (Last Reviewed: April 4, 2008)
3. Is CT chest cardiac score a covered service? (Last Reviewed: April 25, 2008)
4. What requirements are necessary for a radiologist to be paid for the interpretation component of a supervision and interpretation (S&I) code, when the initial or supervision service was performed by another provider? (Last Reviewed: April 25, 2008)
1. Can radiologists provide interpretation of a radiology film(s) as a second opinion when requested by another physician? (Last Reviewed: July 16, 2008)
Medicare guidelines for payment of a second interpretation may be found Pub. 100-04, Medicare Claims Processing Manual, Chapter 13, §100. The guidelines state:
“Generally, carriers must pay for only one interpretation of an EKG or x-ray procedure furnished. They pay for a second interpretation (which may be identified through the use of modifier -77) only under unusual circumstances (for which documentation is provided) such as a questionable finding for which the physician performing the initial interpretation believes another physician’s expertise is needed or a changed diagnosis resulting from a second interpretation of the results of the procedure.”
In the radiology section of the Current Procedural Terminology (CPT) Manual, procedure code 76140 is found and has the description “Consultation on x-ray examination made elsewhere.” However, on the Medicare Physician Fee Schedule Database (MPFSDB), code 76140 has a status indicator of “I” – not valid for Medicare purposes. Therefore, when you submit a claim for a second interpretation performed, you may bill the service as follows:
- Code 76499 – unlisted radiographic procedure
- Modifier 26 – to represent that your billed amount represents the professional component of the service
- Modifier 77 – to represent repeat procedure by another physician
Claims billed with unlisted code 76499 will suspend to the Medical Review Department and will be medically reviewed and manually priced, if medical necessity is substantiated in the clinical record.
2. Is a separate order from the physician required when x-rays are taken intraoperatively? (Last Reviewed: April 4, 2008)
A separate order from the physician is not required when x-rays are taken during a surgical procedure. You do need to document in the patient record that the x-rays were taken intraoperatively.
3. Is CT chest cardiac score a covered service? (Last Reviewed: April 25, 2008)
Per the Computed Tomography (CT Scans) local coverage determination (LCD), # RD003E07, “Ultrafast CT scan of the heart (electron-beam computed tomography) used to demonstrate the presence of coronary calcification in patients with athrosclerotic heart disease is not a covered service.”
4. What requirements are necessary for a radiologist to be paid for the interpretation component of a supervision and interpretation (S&I) code, when the initial or supervision service was performed by another provider? (Last Reviewed: April 25, 2008)
The documentation must support the service being billed. If only a portion of the service described by the S&I procedure code is performed, then the 52 modifier (reduced services) should be appended. It is important that each provider involved document the component of the service they provided, and both providers should submit the claim with the 52 modifier. Communication between providers is desirable. If the provider carrying out the supervision component also provides an acceptable written interpretation, then Medicare would not pay for a second interpretation (or over read) by the radiologist. If documentation is not clear, payment determination is problematic.
The issue of S&I of radiology services is addressed in Pub.100-4, Medicare Claims Processing Manual, Chapter 13, §80.1. It explains that the personal supervision (the “S”) may be performed by the provider who is actually performing a procedure, and the interpretation (the “I”) may later be performed by another physician. Medicare will make payment for the fragmented S&I code at no more than if a single physician furnished both aspects of the procedure.
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Radiology