Billing and Coding Article

Billing and Coding: Radiology Services: Multiple, Identical Services on Same Day

A53488

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Contractor Information

Contractor Name	Contract Type	Contract Number	Jurisdiction	States
Palmetto GBA	A and B MAC	10112 - MAC B	J - J	Alabama
Palmetto GBA	A and B MAC	10212 - MAC B	J - J	Georgia
Palmetto GBA	A and B MAC	10312 - MAC B	J - J	Tennessee
Palmetto GBA	A and B and HHH MAC	11202 - MAC B	J - M	South Carolina
Palmetto GBA	A and B and HHH MAC	11302 - MAC B	J - M	Virginia
Palmetto GBA	A and B and HHH MAC	11402 - MAC B	J - M	West Virginia
Palmetto GBA	A and B and HHH MAC	11502 - MAC B	J - M	North Carolina

Article Information

General Information

Article ID
A53488

Article Title
Billing and Coding: Radiology Services: Multiple, Identical Services on Same Day

Article Type
Billing and Coding

Original Effective Date
10/01/2015

Revision Effective Date
10/10/2019

Revision Ending Date
N/A

Retirement Date
N/A

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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CMS National Coverage Policy

CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 13, §100.1

Article Guidance

Article Text

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.

Response To Comments

Number	Comment	Response
1

Coding Information

Bill Type Codes

Code	Description
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Revenue Codes

Code	Description
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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

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Group 1

(2 Codes)

Group 1 Paragraph

N/A

Group 1 Codes

Code	Description
76	REPEAT PROCEDURE BY SAME PHYSICIAN: THE PHYSICIAN MAY NEED TO INDICATE THAT A PROCEDURE OR SERVICE WAS REPEATED SUBSEQUENT TO THE ORIGINAL PROCEDURE OR SERVICE. THIS CIRCUMSTANCE MAY BE REPORTED BY ADDING THE MODIFIER -76 TO THE REPEATED PROCEDURE OR SERVICE OR THE SEPARATE FIVE DIGIT MODIFIER CODE 09976 MAY BE USED.
77	REPEAT PROCEDURE BY ANOTHER PHYSICIAN: THE PHYSICIAN MAY NEED TO INDICATE THAT A BASIC PROCEDURE OR SERVICE PERFORMED BY ANOTHER PHYSICIAN HAD TO BE REPEATED. THIS SITUATION MAY BE REPORTED BY ADDING MODIFIER -77 TO THE REPEATED PROCEDURE/SERVICE OR THE SEPARATE FIVE DIGIT MODIFIER CODE 09977 MAY BE USED.

ICD-10-CM Codes that Support Medical Necessity

N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code	Description
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N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code	Description
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N/A

Other Coding Information

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format

Code	Descriptor Generic Name	Descriptor Brand Name	Exclusion Effective Date	Exclusion End Date	Reason for Exclusion
			N/A	N/A

Non-Excluded CPT/HCPCS Ended Codes - Table Format

Code	Descriptor Generic Name	Descriptor Brand Name	Exclusion Effective Date	Exclusion End Date	Reason for Exclusion

Revision History Information

Revision History Date	Revision History Number	Revision History Explanation
10/10/2019	R6	This article is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual. Under *Article Title* changed the title from “Radiology Services: Multiple, Identical Services on Same Day” to “Billing and Coding: Radiology Services: Multiple, Identical Services on Same Day”. Under *CMS National Coverage Policy* added CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 13, §100.1. Under *CPT/HCPCS Modifiers Group 1: Codes* added modifiers 76 and 77. CPT^® was inserted throughout the article where applicable. Formatting, punctuation and typographical errors were corrected throughout the article.
02/26/2018	R5	The Jurisdiction "J" Part B Contracts for Alabama (10112), Georgia (10212) and Tennessee (10312) are now being serviced by Palmetto GBA. Effective 02/26/18, these three contract numbers are being added to this article. No coverage, coding or other substantive changes (beyond the addition of the 3 Part B contract numbers) have been completed in this revision.
10/06/2016	R4	Annual validation with no revisions made.
10/06/2016	R3	Under *Article Text* in the last sentence citing the CMS Citation, the “4” in “Section 100.14” was deleted and revised to read “Section 100.1”.
05/19/2016	R2	Removed the link from *CMS Manual Explanations URL(s)*.
10/01/2015	R1	Added code from Article Text to CPT/HCPCS Coding Section. Added CMS Citation to Associated Documents.

Associated Documents

Updated On	Effective Dates	Status
10/02/2019	10/10/2019 - N/A	Currently in Effect	You are here
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Keywords

Radiology
Multiple
Services

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Billing and Coding: Radiology Services: Multiple, Identical Services on Same Day

Document Note

Note History

Contractor Information

Article Information

General Information

CMS National Coverage Policy

Article Guidance

Response To Comments

Coding Information

Bill Type Codes

Please accept the License to see the codes.

Revenue Codes

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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

Group 1

ICD-10-CM Codes that Support Medical Necessity

Group 1

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

ICD-10-PCS Codes

Group 1

Additional ICD-10 Information

Bill Type Codes

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Revenue Codes

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Other Coding Information

Group 1

Coding Table Information

Revision History Information

Associated Documents

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