Emergency Room Radiology
Emergency Room Radiology Question and Answers
1. Can a radiologist and/or emergency room physician bill for an x-ray or EKG procedure when performed in the emergency department?
Any physician credentialed by the hospital can bill for an x-ray or EKG procedure if they have performed a formal “interpretation and report”, which addresses the findings, relevant clinical issues, and comparative data associated with the procedure. However, a physician cannot bill separately for a “review” (e.g., wet read) of the procedure. A “review” is included in the emergency room evaluation and management (i.e., consultation) payment. In addition, the evaluation and management section of the Current Procedural Terminology (CPT) Manual 2005 (Standard edition, page 2) states that, “the interpretation of diagnostic test results with the preparation of a separate distinctly identifiable signed written report may also be reported separately, with the appropriate CPT code with modifier.”
2. Which claim will Medicare pay when multiple claims are received for the same service but provided by different physicians?
Generally, the first claim received by Medicare will be paid and, typically, the second claim will be rejected as a duplicate. The carrier should pay for the report that directly contributes to the diagnosis and treatment of the individual patient for which a formal written report is on file. Ideally, only one claim is submitted, therefore CMS encourages that physician groups in hospitals negotiate in an effort to develop an internal policy.
For further information regarding this issue please see the article titled “ACR Receives Final Instruction on X-Ray in the Emergency Room”.