X-Ray

“I know United Healthcare changed the processing of claims for podiatrists this year when an office visit is billed with an x-ray. However, now I am seeing the same issue with Anthem Blue Cross Blue Shield. New patient office visits are even being denied when billed with an x-ray. We have an x-ray unit on site, take our own x-rays, and our podiatrists read the x-rays. Do you have any advice for how to dispute some of these new patient office visits that are being denied as being included in the payment for the Xray?”

“A new patient was seen with heel pain. X-rays were taken at an outside facility, and I independently interpreted these and reviewed the labs. Based on medical decision making, I believe I should be coding E/M code 99204. The patient had one new, acute problem (previously undiagnosed) and I independently interpreted tests. To me this is a no brainer, but my office staff argues that they believe it should be E/M code 99203.”

“We have a disagreement among our group regarding radiology billing. If a new patient presents with x-rays, MRI, etc., from an outside source, without a report (or with an inadequate report), can the podiatrist bill for the professional component of reading the imaging studies provided?”