A clarification and a comment.
According to Medicare, they will only pay for the radiologist
read AND the ED physician interpretation if the radiologist is
specifically asked to consult on a film. E.g. you are reading
a film and think you see a small pneumothorax but are unsure.
You ask the radiologist to come in and look at it for you to
give you their opinion. As we know this is a rare occurrence.
They do have to add a modifier to bill.
If the radiologists are doing overreads the next day, that is
a QA function that Medicare has already paid the hospital for
with Part A payments. They will not pay the ED physician contemporaneuos
reads and the QA read by the radiologist; only one or the other,
and the contemporaneuos one is favored.
As for ultrasound, there is nearly no conflict between radiologist
and ED physician interpretation billing. This is because ED physicians
do only limited exams (or guidance exams) which have their own
CPT codes, and radiologists almost always perform complete exams
which are different codes. The radiologists and ED physicians
are not charging the same codes and so there is no conflict.
Rebecca Parker, MD, FACEP
ED Medical Director St. Therese Medical Center
Consultant Coding, Billing & Compliance
Team Parker, LLC, www.teamparker.net
Date: Fri, 27 Dec 2002 17:05:25 -0600
From: jay pershad <[log in to unmask]>
Subject: Radiology billing
Dr Nager (Alan):
I wanted to add to what Dr's. Parker, King and Herman already
Yes, under Medicare rules,radiology can also be reimbursed for
overreads. Utilizing a -77 modifier, a repeat service by another
physician is recognized. You can structure it such that, when
you order =
a radiograph it is an implied radiology consult for a delayed
over read. =
One arrangement to consider as you dialogue with the hospital
administration and radiology departments, is for ya'll to bill
services rendered after 5 pm, if they are unable to provide real
I strongly believe that we need to confront this issue eventually.
On a =
similar note, why should ED billing for bedside FAST ultrasound
say, be any different from a concurrent plain radiographic reading
I am not suggesting confrontation, however, the reality is that
contemporaneous radiology interpretation by emergency physicians,
their attendant risks, are not encompassed in the standard point
for E&M coding levels. So, how do we incorporate this part of
service we render??=20
I feel your pain ......
Jay Pershad, MD, FAAP
Division of Pediatric Emergency Medicine
UT College of Medicine =20
LeBonheur Children's Medical Center
Memphis, TN 38103
Pediatric Emergency Specialists, PC=20<<
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is: