Editor’s Note: Cutting through the red tape to make certain that you get paid for every dollar you earn has become more difficult than ever, particularly in our current climate of health care reform and ICD-10 transition. The ACEP Coding and Nomenclature Committee has partnered with ACEP Now to provide you with practical, impactful tips to help you navigate through this coding and reimbursement maze.
Question: Can I bill for my interpretation of ECGs and X-rays?
Answer: Yes, you are permitted to bill for interpretation of ECGs and X-rays, but certain criteria must be met. First and foremost, an “interpretation” is different than a “review.” If you independently visualize or review a diagnostic test, this work is incorporated into the level of medical decision making. If you perform an interpretation, the written report should be similar to what a specialist in the field would prepare. It must be your interpretation, not someone else’s. Medicare and some other payers have stated that they will pay for interpretations that contribute to the diagnosis or treatment of patients but usually only one interpretation. Some payers do reimburse for both contemporaneous and final (QA) readings. Therefore, you might consider having discussions with other services that may want to bill for concurrent or delayed readings. Some institutions require credentialing in order to “officially” interpret certain studies. For more information, see ACEP’s FAQ on this topic.
Brought to you by the ACEP Coding and Nomenclature Committee.
Dr. Lempert is chief medical officer, coding policy, at TeamHealth, based in Knoxville, Tennessee. Dr. Lemanski is associate professor of emergency medicine at Baystate Medical Center/Tufts University School of Medicine in Springfield, Massachusetts, and chair of the ACEP Coding and Nomenclature Committee.