Billing for Review of X-Rays

Q: How do I bill for reading X-rays that a patient brought to my office?

A: To answer your question clearly and correctly, I must first break down the components of X-ray billing. The basic elements are the physical taking of the X-rays (the technical component) and the interpretation/reading of the films, which includes a written report (the professional component). When a single provider performs these components, billing for all of the factors is included in the code for the X-rays. For example, if taking a 2-3 view cervical spine X-ray, the code to use would be 72040 for taking, reading and a written report of the X-rays.

Because of the separate nature of each component, the components can be divided. For example, a doctor may not have X-ray equipment and thus may refer the patient elsewhere to have the X-rays taken. This provider would only perform the technical portion of taking the X-rays, but not any of the professional (reading and report) factors. The films would then be sent to the referring doctor for the professional component. In this scenario, the provider who took the films would bill the specific code for the X-ray with modifier -52 to indicate that a lesser service was performed. This lesser service means that only the technical portion of the X-ray was done. Charges and payments for technical components on most spine X-rays are generally 60 percent of total charges. For the doctor doing the professional component, the base code for the X-ray films would be the same, but for that service, the doctor would add modifier -26 to the code. This modifier is specific to "professional component" and would indicate doing the reading and report specifically. Charges and payments for professional components on most spine X-rays are generally 40 percent of the total charge.

Understanding this, one might construe that you should or could bill for X-rays brought into your office with the modifier -26 for professional component. That understanding is false. Typically, when a patient brings X-rays into the office, the films have already been read by the facility or provider who took them and should have the report attached. Even if the report is not attached, a provider may not bill for reading films that have already been read. In certain circumstances in which the review of films takes more than 30 minutes, the proper code to bill would be 99358, which is the code for review of extensive records. However, this would almost never apply, as most doctors do not spend that amount of time reviewing films. Therefore, the review of films, unless 30 minutes or more was spent, is neither separately coded nor reimbursed, but is simply bundled into the exam and/or other services done the same day.

There is also a code that is for X-ray consultation, 76140, a service that is utilized by a radiologist or other consultant who reads an X-ray (or any diagnostic imaging study) but does not actually see the patient. This is not used when a patient brings the film for you to simply review as part of his or her past record.

To summarize, you may certainly review and do a report of X-rays brought into your office by a patient, but the value of that service is bundled into the evaluation and management services, as it is one of the key components of medical decision-making and is not billed as a separate service. If the films are extensive and require more than 30 minutes to review, you may bill 99358. If doing so, be sure that the documentation of what is reviewed and the time are clearly indicated in the record.