CODING FOR SECOND-OPINION RADIOLOGY CONSULTATIONS

A radiology report is required whenever x-rays are produced. If a facility produces x-rays in their own office, that doctor is expected to produce an accompanying report. Billing, using the typical global code and fee, is appropriate for that service.

For example: a 2v lumbar study, billed as 72100, would include the production of the x-rays and the report

If a diagnostic or management question persists even after the doctor has already interpreted his/her own x-rays and written a report, a separate second opinion service is required. The radiology consultant’s second opinion can be billed as a separate service, using the -26 code, since this additional service is necessary in order to proceed with case management.

	Using the above example, the originating doctor would bill 72100 and the radiology consultant would bill 72100-26.
	Occasionally a third party payer questions what looks to them like a repeat service. In these cases, documentation of why the second opinion consultation was necessary usually resolves the situation and allows payment for both services.

If a doctor routinely send all x-rays out for interpretation, without producing any in-office report, then it is appropriate for that office to bill only for the technical component, using the modifier -TC, and billing a lesser fee than would be used for a global service (usually approximately 60%). The radiology consultant performing the interpretation would then use the -26 modifier and bill approximately 40%.

	Production of 2v lumbar spine x-rays without interpretation: 72100-TC
	Production of report by radiology consultant: 72100-26