Monday, August 2, 2010

Treating Physicians: Separate X-Ray Report Reimbursement Guidelines



Treating physicians may be reimbursed for the professional component of an X-ray procedure performed on a recipient in an outpatient setting (including an emergency room), in addition to being reimbursed for Evaluation and Management (E&M) Procedure-4 codes 99201 – 99499 (except 99211), when a separate report is produced that includes an interpretation and written report for the recipient’s medical record.  The X-ray interpretation should be a separately written report and not simply contained within the E&M report.

Note:    Treating physicians (such as but not limited to emergency room physicians, orthopedic surgeons, trauma specialists, surgeons, internists, family physicians and podiatrists) who routinely review radiographs as an integral part of their reimbursed E&M services are usually not entitled to reimbursement for the professional component of the radiographic review.  This service, like other diagnostic data evaluations, is usually covered by the reimbursement for the E&M.

The separately written interpretation is reimbursable only for Procedure-4 codes 70010 – 77084 and must include the following:

•    Recipient’s name and hospital identification number (if applicable)
•    Name or type of examination
•    Date of examination
•    Interpretation that includes a complete exam of the X-ray using precise anatomic and radiologic terminology
•    Pertinent clinical issues and an “impression” section
•    Signature of the physician supplying the interpretation

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