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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.
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For example: a 2v
lumbar study, billed as 72100, would include the production of the
x-rays and the report
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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.
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Using the above example, the originating
doctor would bill 72100 and the radiology consultant would bill
72100-26.
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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.
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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%.
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Production of 2v lumbar spine x-rays without
interpretation: 72100-TC
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Production of report by radiology consultant: 72100-26
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