May 9, 2019
A patient presents with a CD of an X-Ray that was performed at another institution that was previously read by the radiologist. If one of my surgeons reads the X-Ray I can we bill for the second reading?
No, reading an X-Ray that was taken elsewhere, and previously interpreted by a radiologist, is not a separately billable service for the surgeon. This work of reviewing the images or the reports of the previously interpreted X-Ray is included in the medical decision making (MDM) of the Evaluation and Management code billed for that visit. The surgeon receives “credit” for his/her personal review of the images in the Data Reviewed element of the MDM. Two points are credited for the independent review of the actual images; one point is credited for review of a report. A total of three points may be credited if the surgeon documents the review of both the images and report.
The MDM rules for reviewing an outside X-Ray differ from the professional interpretation of X-Rays taken in the office setting where the surgeon also reports the global radiology code or the radiology code with a PC (professional component) modifier. In the latter scenario, the surgeon only receives credit (1 point) for ordering the images.
*This response is based on the best information available as of 5/9/19.