May 1996 AAOS Report

HCFA tells rules for payment of X-ray interpretation

Orthopaedic surgeons and other physicians can now bill Medicare for their interpretation of X-rays taken in hospital emergency departments. The Health Care Financing Administration (HCFA) has directed Medicare carriers to pay for only the interpretation of an X-ray that directly contributes to the diagnosis and treatment of the emergency room patient. Medicare will pay for two interpretations only under unusual circumstances such as a second interpretation of a questionable finding by another physician. Physicians are to bill only the professional component of the radiology code by using modifier -26. In order to bill for the interpretation, an official and separate written report must be placed in the hospital record. Carriers are encouraging hospitals to work with their medical staffs to ensure that only one claim per interpretation is submitted. Carriers also should be advising hospitals that a second or "official" hospital interpretation of an X-ray will be considered a quality control activity, covered under the hospital payment. Reportedly, some Medicare carriers continue to be concerned that they will receive more than one bill for interpretation of X-rays despite the directive from HCFA.

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