ED Coding and Reimbursement Alert

See through your problem claims with these expert tips

If you can't get a handle on coding x-ray services, you-re not alone. But as long as you document the x-ray type and quantity, you-ll be on your way to x-ray coding expertise. Secure reimbursement for these procedures with the following expert answers. Standing Knee View Won't Always Warrant 73565 Question 1: The patient receives a two-view left knee x-ray while lying flat, and another left knee x-ray while standing up. Can you report both 73560 (Radiologic examination, knee; one or two views) and 73565?

Answer: No. Because 73565 (Radiologic examination, knee; both knees, standing, anteroposterior) describes -both knees,- you cannot report this code if the physician only examines one knee.

Instead, you should add up the total number of views that the physician took, says Anne Crandall, LPN, office manager at Spine and Sports PC in Memphis, Tenn. Therefore, if the doctor performs two views of the left knee while the patient lies in the supine position and one standing view of the left knee, you should report 73562  (... three views).You should report 73565 only if the physician orders anteroposterior (AP) upright views of both knees. Document X-Ray View Types, Not Just Quantity Question 2: The ED physician requests a complete cervical spine x-ray series. The x-ray technologist shoots and documents five spine views, so you report 72052. Is this the correct code?

Answer: Determining the correct code is impossible, says Cheryl A. Schad, BA, CPCM, CPC, owner of Schad Medical Management, a medical reimbursement consulting firm in Mullica Hill, N.J. The x-ray tech may have shot five views, but because the tech didn't document the types of views, you can't tell whether she performed a complete series or whether she simply shot five anteroposterior AP views. You probably assume that the tech would never perform five AP views, but you-ll find it impossible to prove otherwise without the appropriate documentation.

Although x-ray technologists should always document the number and types of radiologic views they take, the types of views--not just the number--will help you determine your code.

If the doctor dictates only five cervical spine views, the highest code you can assign is 72050 (Radiologic examination, spine, cervical; minimum of four views). To report a complete series (72052, Radiologic examination, spine, cervical; complete, including oblique and flexion and/or extension studies), the x-ray tech must shoot bilateral oblique views, a flexion-extension lateral view, and articular pillar (facet) views. If she doesn't document these views, your code automatically defaults to 72050.

In the emergency department (ED), it can also be helpful if the physician specifies the type of study requested. For example, rather than just -C spine,- the physician might state, -four-view C spine- [...]