Correct billing for hospital-based radiology department physicist review of radiation dosing

Q.

Can CPT^® code 76145 be billed by a hospital-based Radiology Department?  If so, who would need to sign the report? Would it be the physicists (most of whom are PhDs) or do we bill it under an MD’s name and credentials?  Is there a Technical and Professional Billing Component for this code?

A.

The code is to be billed by the facility that employs the physicist. That’s usually going to be the hospital. Whether it is billed by the radiology department or another is an internal decision.

As of 2021, Under OPPS it has a status indicator of “S,” APC 5611, the national payment amount of $126.87.

Under the physician fee schedule, the code is a practice-expense only code, with a PE/TC indicator of 0 — so while it’s not a true technical only code, it will be billed by the facility that employs the physicist.

0 = Physician Service Codes — Identifies codes that describe physician services.

Examples include visits, consultations, and surgical procedures. The concept of PC/TC does not apply since physician services cannot be split into professional and technical components. Modifiers 26 and TC cannot be used with these codes. The RVUs include values for physician work, practice expense, and malpractice expense. There are some codes with no work RVUs.

Under the MPFS, this code has no work RVUs. The PE RVU is $24.77 with MP of 0.61 and with a total RVU of $24.88.

It is to be performed by a medical physicist generally employed by the facility, and it is performed after an imaging service instead of before, as in medical physics codes 77370 and 77336. When a patient’s radiation level is higher than the facility’s threshold, this procedure would be performed

From the 2021 AMA CPT Code Symposium:

• Physicist reviews the procedural data for each image acquisition and fluoroscopy sequence;
• Physicist then calculates the dose to skin & other tissues;
• Total dose is summed based on other factors including patient position and body habitus;
• A report is prepared detailing the results and recommendations for follow-up; and
• The report is signed by the physicist.