The ruling on who can bill for overreads comes from Medicare. They state the
physician who contemporaneously reads the ECG/plain films CAN bill for their
reading. Medicare states they pay for the radiologists' overreads, a QA
function, through the inpatient Part A side payments to the hospital.
However, they will pay for the radiologist overread if the contemporaneous
doctor (e.g. ED physician) decides not to bill. The doctors must work it out
between themselves, as they will not pay for 2 billings. Medicare has stated
these things in the federal register so if you decide to have the
radiologist bill for their overreads it is not a compliance issue.
As for other payers, Medicaid usually follows the CMS/Medicare rules, but it
can vary by state. Private payers varies by private payer, but essentially
they follow the AMA/CPT guidelines. CPT states that any physician can bill
any CPT code if they provided the service. Most payers will pay for the
first bill they receive and then deny the other if 2 physicians bill for the
same service with an occasional exception (if you request the radiologist to
read the film too they can bill for their service as well, with the
appropriate modifier. Medicare and others will pay for both
So, you must work this out with your radiologists, and it will be a battle.
Many places have used the Medicare ruling to get better radiologist
services, and some do bill for the ED interpretation. Keep in mind in order
to bill the report must be similar to what a specialist would write, which
is more than most ED physicians write.
Check out http://www.acep.org/1,201,0.html for more details on this issue.
Rebecca Parker, MD, FACEP
ED Medical Director St. Therese Medical Center
Consultant Coding, Billing & Compliance
Team Parker, LLC, www.teamparker.net
On 12/18/02 11:01 PM, "Automatic digest processor"
<[log in to unmask]> wrote:
> Date: Wed, 18 Dec 2002 18:29:58 -0500
> From: "Alan L. Nager, MD" <[log in to unmask]>
> Subject: Radiology Readings in the ED
> I recently conducted an informal, on-the-spot, telephone survey to
> determine whether Pediatric Emergency Departments get a partial or full day
> immediate "reads" from a radiologist for all radiologic studies ordered. I
> was surprised that of the 21 hospitals called, the results showed the
> following: 7 hospitals (33%) had 24 hour radiology readings; 6 (29%)had
> formal radiology readings during the day shift only - usually ending around
> 6 pm; 8 hospitals (38%) the ED physicians read the films and then had a
> formal reading the next day by radiology. A secondary issue is that, after
> doing some investigation regarding billing practices, it appears that
> delayed interpretations by radiology are considered "over-reads" for
> quality control purposes only and should not be billed.
> I would appreciate your thoughts and comments.
> Alan L. Nager, MD
> Childrens Hospital Los Angeles
> Division of Emergency Medicine
> [log in to unmask]
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