Multiple 'Serial' X-Rays
Medicare Part B claims for multiple, identical services provided to an individual patient on the same day may be denied as duplicate services. To ensure correct claims processing:
•Submit multiple, identical services on the same claim,
•Use the days/units field when possible to identify multiple procedures,
•Indicate the time each service was performed in the appropriate documentation field for electronic claims or Item 19 of the CMS-1500 claim form,
•Use CPT® modifier 76 for multiple, identical services performed on the same date of service by the same physician.
Example:
| Date of Service |
CPT Code/Modifier |
Days/Units |
| 1/1/13 |
73000 |
1 |
| 1/1/13 |
73000-76 |
2 |
Multiple Interpretations, Same X-Ray
Generally, Palmetto GBA may reimburse the first interpretation of an X-ray furnished to an emergency room patient. The 'interpretation and report' of an X-ray requires a complete, written report similar to the kind of report a specialist would prepare. Payment for a second interpretation of the same film is made only in unusual circumstances. Claims for the second interpretation of the same film must be submitted with CPT® modifier 77 when performed by a different physician and must provide documentation as to why a second interpretation is medically reasonable and necessary.
Examples:
•A questionable finding for which the physician performing the initial interpretation believes that another physician’s expertise is needed,
•A changed diagnosis resulting from a second interpretation of the results of the procedure.
Palmetto GBA will not reimburse 2 interpretations of the same X-ray without the additional required documentation. When an emergency room physician and a radiologist both perform interpretations of the same X-ray, both physicians should work together to determine who should submit the claim.
Additional information and guidance on multiple interpretations of the same X-ray are available in the CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 13, §100.1.
