Radiography billing covers 2 components:
- Technical component (cost of film, processing, and equipment) - about 40% of the global fee
- Professional component (time and expertise of the clinician) - 60% of the global fee
Choose one of 3 coding options
This example uses CPT code 72100, a two-view lumbar spine series.
1. If you take and read most or all of your films
You have 2 options a) A global fee (i.e., 72100) which includes technical and professional components - OR b) Separate technical and professional components (72100-TC or plus the professional component or reading fee 72100-26). Your report is the primary report. You can get a second opinion by using the 76140 code, when needed.
2. If you have all of your films read by a radiologist
Use 72100-TC for the technical component and 72100-26 for the professional component. You would then pay the radiologist from the 72100-26 component. The primary report will be produced by the radiologist.
3. If you have only some of your films read by a radiologist
This is an overread (second opinion) service. Since a global fee typically has already been billed, you should only use the overread code - 76140. The insurance company considers it double billing for the professional service if you use the -26 extension. Using the 76140 code assumes a primary report already exists.
Note: Good patient care requires that all radiographs taken include a written interpretation. These reports can be done by the general practitioner or by a board-certified radiologist, sometimes by both.
For questions, contact:
Lynn Schmidt, insurance specialist
952/800-888-4777 ext. 245