Reader Questions: Know When to Use Modifier 59 on X-Ray Claims

Question: A physician in our facility ordered a three-view foot x-ray after he performed arthroplasty of the foot. The carrier is denying the claim, stating that the three-view x-ray cannot be reported with the two-view x-ray that the patient had prior to the surgery. What am I doing wrong?

New Hampshire Subscriber

Answer: If you’re not using a modifier, you are billing incorrectly. You need to append modifier 59 (Distinct procedural service) to the code for the two-view x-ray (73620, Radiologic examination, foot; two views) to overcome the NCCI bundle between 73620 and 73630 (Radiologic examination, foot; complete, minimum of three views).

The modifier indicates to the payer that the two x-ray services were distinctly separate from one another and should be separately reimbursed.

Tip: Remember, you need to have separate and distinct written orders and radiology interpretations for these procedures to support billing them separately.