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Thread Topic: X-ray reports
Topic Originator: Rich
Post Date August 23, 2012 @ 2:46 PM
X-ray reports


Rich
August 23, 2012 @ 2:46 PM Reply  |  Email Friend   |  |Print  |  Top

Our practice has an in-house X-ray suite. The provider, who is not a board-certified radiologist, has been interpreting these in-house and billing insurance for both the professional and technical components accordingly.

We are now about to start outsourcing the interpretation of X-rays to a board-certified radiologist. The provider wants to impose a $15 charge, payable at date of service, on patients to cover the costs of this interpretation. This charge will be levied on all patients, insured or uninsured, including Medicare patients.

I am concerned that this will involve us charging Medicare patients for services covered by Medicare, and so expose us to significant liability. I believe we should be billing for X-rays with the -TC modifier (technical component only) and letting the radiologist bill for the professional component with the -26 modifier. Can anybody point me to something authoritative I can show my provider about this? Or something authoritative that proves me wrong...

Leigh
March 28, 2016 @ 11:18 PM Reply  |  Email Friend   |  |Print  |  Top

We do our own echos and ultrasounds in our Med-Peds clinic. We pay the tech a flat fee per study. We send echos to a cardiologist to be read and pay a flat fee. The other ultrasounds are read by a radiologist who pays us a flat fee dependent on the type of study. We did the math with us billing global and paying for services versus billing with modifiers. We found that we made more money billing global. It's not a liability issue because when the radiologist signs off on his report, he assumes the libality. Plus if the radiologist billed with a modifier, you'd have to get then patient demographics and insurances. You'd have to supply medical necessity and help them with denials. If someone screws up and forgets the modifier, your charges will get denied duplicate and will take forever to fix.

I'd consider each CPT code individually, factoring in expenses for supplies, staff, courier to get films to radiologist if not using PACS, and their $15 fee to see what you'll earn after expenses. $15 a study seems off to me. There's more to read on a chest X-ray than on a knee series. I'd imagine that you could negotiate a cheaper reading fee on some studies.



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