Medicare Compliance & Reimbursement - 2019 Issue 1
Reader Question: Don't Bundle E/M and X-ray
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Article Overview
This reader Q&A explains a common outpatient coding scenario involving an established patient, an office E/M visit, and an in-office hip X-ray. It is aimed at coders, billers, and practice staff who need to understand how the services are generally handled together for claim reporting and what broad payer considerations may apply.
Why This Topic Matters
Articles like this help reduce avoidable claim errors in same-day office visits that include both evaluation and diagnostic imaging. Understanding the general scope of this guidance can help practices review when additional reporting elements may or may not be considered necessary by payers.
Article Sections
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Question
Presents a billing scenario involving an established patient, an office evaluation and management visit, and a same-day hip X-ray performed in the surgeon’s office.
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Answer
Summarizes the general coding treatment of the two services and identifies the code sets discussed in the response.
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No modifier 25?
Discusses payer conventions around same-day reporting and broader considerations for whether an additional E/M modifier may be expected.
What You Will Learn
- How the article frames a same-day office E/M and diagnostic imaging scenario
- What broad claim-reporting considerations are discussed for office-based X-ray services
- How payer expectations are described at a high level in relation to same-day reporting
- What type of coding guidance the reader question is seeking
Who Should Read This
- Medical coders
- Billing staff
- Physician practices
- Orthopedic/surgical office staff
- Revenue cycle professionals
Codes Discussed
Modifiers Discussed
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