Team Procedures

All too often, the problem in the case of team procedures, where multiple physicians are involved, is that the first physician’s claim that gets submitted wins. This is especially true when another provider takes credit for radiology services.

Let’s take a look at a few examples, to help you figure out how to code your claims to make sure you get a radiology claim to your payer quickly.

Example 1: Do both a radiologist and a speech language pathologist need to be present to code a modified barium swallow procedure?

They may both need to be present. Guidelines recommend that the service be provided in a team setting. Note the use of the word “recommend” instead of “require.” This means that the real decision making is left to individual states and payers. They may choose to be more strict.

Example 2: If you are coding a situation where a surgeon placed a gastrostomy tube percutaneously without an endoscopic component, and you are coding for the radiologist who provided the ultrasound or the fluoroscopy as guidance, which CPT code(s) do you report?

When a radiologist provides guidance for these services, you should report 74350 (this is the radiological supervision and interpretation). The surgeon will report 43750 (this is the placement). If the radiologist simply reads the films though, and isn’t present for the procedure, then you need to use modifiers 52 (reduced services) and 26 (professional component) to the code. This tells the payer that the physician supervised or interpreted, but not both. The surgeon should report the same way.

Be careful when coding multiple physician situations, and you should have no problems with payers. It’s generally a good idea to coordinate with the other physicians, in order to ensure that all parties are reimbursed appropriately.

View all Articles by: Kathryn Etienne, CCS-P