HNS Policy  

For ALL radiology services provided and billed through HNS, the medical necessity for the services must be clearly documented in the patient's health care record, must be properly reported using the most appropriate CPT code and must be consistent with the patient's chief complaint/clinical findings, diagnoses and treatment plan.

1. HNS providers must document all radiology studies performed and/or interpreted in the office.
   

    

2. The area(s) initially x-rayed must be medically necessary and consistent with the patient’s initial chief complaint.
   

    

3. Subsequent x-rays must be medically necessary and consistent with the patient’s chief complaint, clinical findings, diagnoses and treatment plan.
   

    

4. A written radiology report to document the provider’s interpretation of the radiograph(s) must be maintained in the patient’s health care record. These reports must be signed or initialed by the provider and should include:
   

   1. Patient identifying information (patient name, DOB, etc.);
      

       

   2. Date of study as well as an accurate description of the
      radiological findings;
      

       

   3. Impressions; and
      

       

   4. Recommendations for follow-up studies that may be
      needed to reach a final diagnostic impression.
      

       

5. The specific area(s) x-rayed must be documented.
   

    

6. The date of the study must be documented.
   

    

7. The name of the person performing the x-ray study must be documented.
   

    

8. There should be documented, supporting evidence that clinical findings support the need for repeat x-rays.
   

    

9. Routine repetitive x-rays within a 90 day period require the following documentation:
   

   1. Evidence of a new injury reported for the same area as the initially reported area.
      

       

   2. An initially identified pathology or biomechanical aberration requiring further investigation.
      

       

   3. A new symptom in the same area appears which was not present initially.

       

To demonstrate a subluxation by x-ray, the x-ray must have been taken at a time reasonably proximate to the initiation of treatment.

An x-ray is considered reasonably proximate if it was taken: 

1. No more than 12 months prior to the initiation of a course of treatment.
   

    

2. No more than 3 months following the initiation of a course of treatment.

    

Radiographs are generally considered medically necessary only for the purposes of diagnosing specific problem area(s) documented as a chief complaint with supporting objective clinical findings verifying their necessity.

Repeat x-rays must be clinically indicated and the reason(s) clearly documented in the health care record.

For billing purposes, an x-ray “view” is a separate exposure to radiation. Therefore, full spine x-rays cut into sections do not constitute multiple views, unless multiple exposures are taken.

Single view x-rays without opposing views are not considered of diagnostic quality. An occasional “spot shot,” or single view, may be performed as a follow-up to review a specific area in question. 

IMPORTANT NOTE: 

1. Radiology Overreads:
   

   Patients with a health insurance plan that contracts with HNS cannot be billed for radiology overreads. While radiographic overreads are very valuable, the cost for this service cannot be billed to the payor or to the HNS patient. Remember, you cannot collect more than the patient’s co-pay, deductible and/or co-insurance for any covered service provided.
   

    

2. CPT 76140:  (Consultation on x-ray examination made elsewhere.)
   

   This code is a service to be used by a radiologist, or other consultant, who performs a subsequent reading of any diagnostic imaging study but does not actually see the patient. This code should not be reported by HNS providers when reviewing x-rays brought by a patient that were taken elsewhere.

    

   The review of imaging studies included in the CMT work service applies regardless of whether the studies were performed in your office or if the patient brings films to you that were taken elsewhere.

    

   This code would be appropriately reported by a Chiropractic Radiologist who did not actually see the patient, but interpreted the study (please remember that interpreting the study is not the same as an “overread”).
   

    

3. Modifier – 26:  (Professional Component)
   

   This modifier indicates the provider is reporting the professional component only for a service and is often incorrectly reported with radiology codes. Please note that the pre-service work included in the CMT codes and E/M codes includes imaging review and as such, this modifier should not be reported by HNS providers who are also reporting a CMT or E/M code on the same date of service.

    

   Click "Radiology Report" for a sample form provided by HNS. You may also obtain a copy of this form in Microsoft Word format on this website under HNS Forms.