April 1, 2021
Question:
A new patient presents with a CD of an MRI that was performed at an outside institution and was read by the radiologist. There was no report with the CD. If one of my physicians reads the MRI can we bill for the second reading?
Answer:
No, reading the MRI that was taken elsewhere and previously interpreted by a radiologist is not a separately billable service for your physician. This work of reviewing the images or the reports of the previously interpreted MRI is included in the medical decision making (MDM) of the Evaluation and Management code billed for that visit.
Review of images and independent interpretation of outside MRI or other films, not billed by the provider or group practice, falls in the ”Amount and/or Complexity of Data to be Reviewed and Analyzed” element of Medical Decision Making under the 2021 E/M changes that apply to codes 99202-99215.
Review the MDM table, focusing on the Moderate Risk section of the Data element.
You will find this activity listed as Category 2: Independent interpretation of tests. The physician will document that the outside MRI images were reviewed and document his/her personal interpretation of the images.
*This response is based on the best information available as of 04/1/21.
