May 9, 2019

Question:
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?

Answer:
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.