Watch for E/M denials with diagnostic X-rays

Why This Topic Matters

Orthopedic and other specialty practices may face denials when separately reporting E/M services with diagnostic imaging performed at the same encounter. Understanding the difference between payer policy interpretations, Medicare guidance, and documentation requirements helps practices assess denials and determine when claims may be supportable.

Article Sections

1. Reported denial trend and payer policy concerns

   Introduces the denial pattern being reported and the concern that some payer policies may treat diagnostic imaging encounters differently from Medicare guidance.

2. Medicare NCCI and physician fee schedule context

   Summarizes the Medicare framework discussed in the article, including how diagnostic testing is viewed under national bundling and related fee schedule concepts.

3. Commercial and Medicare Advantage policy examples

   Describes how certain payer education materials are presented as interpreting evaluation and management reporting in the imaging setting.

4. Tightened policies may be aimed at radiologists

   Explores why some policies may be focused on radiology-oriented services and how the article frames the distinction between routine and separately identifiable work.

5. X-rays are diagnostic tools for orthopedists

   Discusses the orthopedic setting and the broad circumstances in which imaging is used as part of a broader evaluation of the patient.

6. Don’t count X-rays you perform toward MDM of the visit

   Reviews the article’s discussion of how imaging-related work may interact with evaluation and management medical decision-making calculations.