# Appropriate modifier use with E/M and X-rays



## HCCCoder (Dec 19, 2008)

Hi all, any suggestion will be appreciated. 

I have this case where a new pt came in for the pain within the arm. Doctor performed the Hx, PE and MDM and also has the following note: 

"X-Rays of right elbow (73080), forearm (73090), wrist (73110), 
hand (73130) are negative, PA, lateral and oblique, for any bony abnormalities".

My question is, if I code this case scenario as 99201-99214 (E/M based on what was documented) with 73080, 73090, 73110, 73130, what kind of modifier I need? Or do I even need one? I assume (I did confirm this with the doctor's office) that the dr did the x-ray in his office and read the results. 

Thanks anyone who will answer to my question.


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## jackiels (Dec 19, 2008)

First Rule of coding:  If it wasn't documented it wasn't done
Second Rule of Coding: *Never Assume Anything!*


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## HCCCoder (Dec 19, 2008)

Thank you for your response and I am well aware of those rules. 
Ok, what do you mean "if it wasn't documented, it wasn't done?" 
That's not my question.  
And regarding the x-ray, I did confirm with the doctor and he did that in the office. 
Can you please answer to my question now?

Thank you,
Lilit


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## hbsg11 (Dec 20, 2008)

*Modifier*

You do not need a modifier with the visit, if all x-rays were done in MD's office. 
Am I correct guys?


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## junebug1969 (Dec 22, 2008)

I believe that you would at least need modifier -25 on the E/M service to show that the E/M service was a separate, distinct service. Other than that, I don't think you need modifiers other than directional ones (-RT) on all the X-rays.


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## HCCCoder (Dec 22, 2008)

Thank you very much for all your responses.
I do need some additional information regarding this. Like any supplemental web sites. 
Is there someone who can help?
Thank you,
Lilit


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## pamtienter (Dec 22, 2008)

You don't need a modifier on the visit if you are billing only x-rays in addition to the E/M. I would agree with the RT or LT on the x-rays though. 

Happy Holidays!


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## HCCCoder (Dec 22, 2008)

Thank you very much I appreciate your time.
Lilit 

Happy holiday season to you too!


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