BILLING AND CODING
Payments to CLIC should be made from the ordering physician. However, your practice can bill the patient or a third party payer to cover these services. You should bill at your normal office rate for these services, which may be higher than the CLIC fees for interpretation. Please note that these services are not covered by Medicare, so if your patient is over 65, an ABN form should be obtained and kept on file for your patient at your office.
Billing for Radiographic Imaging has two components:
Technical Component = cost of producing the radiographic image (40% of global fee)
Professional Component = cost of interpretation of the image (60% of global fee)
Quality patient care standards require that a full written radiology report should be generated for all radiographs that are taken. These reports should be generated by a board certified radiologist, the doctor of chiropractic, or sometimes, both.
Three Options for Billing for CLIC services:
1. If you have images taken and read by another imaging center and you would like a CLIC radiologist to generate a second opinion report. This is a full, unbiased, and complete report, performed on images less than one year old. The secondary interpretation code should be used only if a primary, or initial, report was already generated for these images.
2. If you take a radiograph and have a CLIC radiologist read the image & generate the primary report
3. If you take the radiograph and generate a report yourself, but you would like a radiologist’s second opinion
Note: these examples use CPT code 72100, for a two-view lumbar spine series. The base CPT code should be changed to reflect the radiographic series submitted for interpretation. If you need CPT codes for imaging, many of the common ones can be found on our Resources page.
Billing for Radiographic Imaging has two components:
Technical Component = cost of producing the radiographic image (40% of global fee)
Professional Component = cost of interpretation of the image (60% of global fee)
Quality patient care standards require that a full written radiology report should be generated for all radiographs that are taken. These reports should be generated by a board certified radiologist, the doctor of chiropractic, or sometimes, both.
Three Options for Billing for CLIC services:
1. If you have images taken and read by another imaging center and you would like a CLIC radiologist to generate a second opinion report. This is a full, unbiased, and complete report, performed on images less than one year old. The secondary interpretation code should be used only if a primary, or initial, report was already generated for these images.
- CPT Code = 76140 – second opinion report when a primary report has already been generated
2. If you take a radiograph and have a CLIC radiologist read the image & generate the primary report
- OPTION 1: CPT Code = global fee (ie, 72100) for the study performed & primary report generated by CLIC
- OPTION 2: CPT Code = separate and add the modifier codes for both the technical component (ie, 72100-TC) AND Professional component (72100-26).
3. If you take the radiograph and generate a report yourself, but you would like a radiologist’s second opinion
- CPT Code = global fee (ie, 72100) for the study performed AND
- CPT Code = 76140 – professional secondary interpretation by CLIC, after you have already generated a primary report
Note: these examples use CPT code 72100, for a two-view lumbar spine series. The base CPT code should be changed to reflect the radiographic series submitted for interpretation. If you need CPT codes for imaging, many of the common ones can be found on our Resources page.