We will determine the extent of inappropriate payments for diagnostic x-rays performed in hospital emergency departments. In 2004, more than 2.5 million diagnostic x-rays were performed in Medicare-certified hospitals with emergency departments. Interpretations by emergency room physicians of diagnostic x-rays should not be billed separately. We will assess the extent to which Medicare is inappropriately paying for diagnostic x-rays interpreted by emergency room physicians. (OEI; 00-00-00000; expected issue date: FY 2008; new start)

Good News Update 

After this information became public, both Barb Marone, from the ACEP Washington office and EDPMA counsel, Joyce Cowan’s office, approached the OIG to discuss this issue. As a result, in a highly unusual, but appropriate move, the OIG has now published a correction via an ERRATA Sheet where they note:  On page 5 of the Fiscal Year 2007 Work Plan, corrections have been made to the summaries for two studies: 

• Inappropriate Payments for Interpretation of Diagnostic x-rays in Hospital Emergency Departments (OEI:00-00-00000;expected issue date: FY 2008;new start)
• Oversight of specialty Hospitals (OEI; 02-06-00310; expected issue date: FY 2007; work in progress); 

The revised language of the plan follows:

We will determine the extent of inappropriate payments for the interpretation of diagnostic x-rays performed in emergency departments. In 2004, more than 2.5 million diagnostic x-rays were performed in Medicare-certified hospitals with emergency departments. According to the Medicare Claims Processing Manual, contractors are to pay for only one interpretation of an x-ray procedure furnished to an emergency department patient. They pay for a second interpretation, identified through the use of modifier 77, only under unusual circumstances, for instance when the physician performing the initial interpretation believes a specialist is necessary. Documentation must be present to support the second claim. We will determine whether the services were medically necessary and if the tests were interpreted contemporaneously with the patient's treatment. (Revised 10/4/06)

(OEI; 00-00-00000; expected issue date: FY 2008; new start)

It appears that in addition to fast action correcting an obvious error, this may be an opening for approaching the issue of payments made in error to providers who do not read the x-rays contemporaneous with the care of the patient. It will be interesting to see how the OIG approaches this issue.