How to Code and Bill Diagnostic Tests

One of the biggest problems in the urgent care/immediate care setting is ensuring appropriate documentation when performing and billing X-rays. Most facilities have the capability to perform these services as well as provide professional interpretation. Some common radiology services include chest X-rays, EKGs, examination of the extremities, etc.

There are three ways to report X-rays:

1. Billing the technical component

2. Billing the professional component

3. Global billing

The technical component includes the actual performance of the X-ray, the technician who takes the X-ray, the film, and equipment and supplies. The technical component is reported with the CPT/HCPCS level II code and modifier TC (technical component).

The professional component for the radiology portion of the procedure is referred to as “supervision and interpretation.” When a physician reads and interprets a radiology service and provides a written report, this is reported with the appropriate CPT/HCPCS level II code and modifier 26.

Global billing is the combination of the professional and technical component. This includes the actual performance of the X-ray, technician, supplies, equipment, and the supervision and written interpretation in the form of a report.

CPT definition of a written report is considered part of a radiologic procedure or interpretation.

It is important to keep in mind that what is billed must be reflected in the documentation. It is also important to ensure that the description of the code used reflects the service provided.

Physicians and coders alike are frequently confused as to whether a separate written report is required for coding and billing X-rays to support claims for the professional component of a radiology service in the urgent care setting. Typically, urgent/immediate care facilities own or lease the equipment, employ the staff, and interpret the X-ray. Most physicians in this specialty are qualified to read and interpret X-rays. In this case the physician will report the global code.

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