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Radiology Billing and Coding: Postreduction X-rays


Same Provider, Same Number of Views

When the same provider reads the same number of pre- and postreduction views, he or she will report two units of the appropriate CPT code, and append modifier 76, "repeat procedure or service by same physician or other qualified health care professional" to the second unit. 

Same Provider, Different Number of Views

If the same provider reads both the pre- and postreduction films, but the prereduction X-ray differs from the postreduction X-ray (eg, three views prereduction and two views postreduction), separately report the appropriate CPT code for each X-ray and append modifier 59, "distinct procedural service" to the postproduction X-ray code. 

An exception to the above rule applies for some Medicaid payers, who will require you to report the second procedure with modifier 76 when the same provider interprets both films, regardless of the number of views.

Different Provider, Same or Different Number of Views

The coding also changes if a second provider performs the postreduction X-ray and the X-ray orders are the same, pre- and postreduction, such as three views for each. Under these circumstances, append modifier 77, "repeat procedure or service by another physician or other qualified health care professional," to the postreduction X-ray code 
If a different provider reads the postreduction X-ray and the number of views also changes, you should append modifier 59 to the postreduction code

Additional Modifiers May Apply

In all the circumstances described above, you would also apply any appropriate anatomical modifiers (RT for right side, LT for left side), as necessary, to describe the location at which the X-rays are taken.

Additionally, when reporting only the provider's interpretation of the films, you must append modifier 26, "professional component" to all X-ray codes. Only if the provider supplies both the professional and technical components of the service in a nonfacility setting (for instance, by providing the X-rays in her own office, using her own equipment) may he or she report the appropriate CPT code without modifier 26.

As always, you may report X-rays and other radiology services only with a signed order by the treating physician, and only if a separate radiology report is generated. 

Reference: www.radiologytoday.net

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