ED Coding and Reimbursement Alert

Collect every time for your ED radiographs with these quick tips.

You're most likely reporting x-rays multiple times a day in the emergency department, but coding them can sometimes be just as complicated as interpreting them. Check out the following three quick tips so you know how to report those services and avoid denials.

Tip 1: Different Sites Should Mean Different Views

One of the most important aspects of coding for x-rays is to always bill for the number of views and anatomic sites that the physician reviews. Although coders are often worried about overcoding, you also want to collect for all the views performed, so you should review the medical reports thoroughly.

For instance, suppose a patient presents following a bicycle accident and the doctor documents that the ED "performed an x-ray for suspected clavicle fracture and examined the AC joint." Although some coders might assume this means that only a clavicle x-ray was performed, the reality is that the doctor probably ordered and interpreted multiple films. You should check the medical record to see whether multiple x-rays are recorded, and if so, you should bill for all of them.

Therefore, in this case, you'll likely report both 73000 (Radiologic examination; clavicle, complete) and 73050 (Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction). Keep in mind that 73050 applies when your physician does x-rays of the AC joints on both the right and the left sides. If your physician performs the imaging on only one acromioclavicular joint, you'll append modifier 52 (Reduced services) to 73050.

Tip 2: Keep Thorough Documentation

Every medical practitioner and coder knows that documentation is key to supporting the claims you submit, but not everyone follows through on the commitment to be thorough. When it comes to reporting x-rays, this is immeasurably important, since most radiography codes are reported based on the number of views, and without recording that information, EDs may be forced to downcode their claims.

Example: The practice performs a four-view x-ray of a patient's left knee, including lateral and sunrise views in both standing and non-standing positions. You report 73564 (Radiologic examination, knee, complete, 4 or more views). The documentation for the claim simply says, "Standing/non-standing left knee x-ray."

Unfortunately, this note is not thorough enough to support billing a four-view x-ray, because even though the doctor may have circled 73564 on the claim, the documentation does not indicate that four views were taken. If a payer audited this note, you would likely be downcoded to 73560 (Radiologic examination, knee; 1 or 2 views), giving you credit for one view of the knee in standing position and one view in non-standing. Since 73560 pays about $31 and 73564 reimburses about $40, you'd have to refund $9.00 to the payer for this claim.

Remind your physicians of the importance of thorough documentation regarding the number of views so you can ensure that this mistake doesn't happen in the future.

Tip 3: Know the Definition of 'Minimum'

Many of the x-ray codes refer to the minimum number of views required to bill that particular code, but if you perform more than the minimum, you might be stymied on what to do. The reality is that you must often defer to the "minimum" code even if you performed many more than that number.

Example:  A patient presents to the ED with severe shoulder pain that he reports as a nine out of ten on the pain scale. The physician obtains three shoulder views and the coder reports 73030 (Radiologic examination, shoulder; complete, minimum of two views) for the first two views, as well as 73020-59 (Radiological examination, shoulder; 1 view; Distinct procedural service) for the third.

This example represents an upcoding situation. When you have a code that specifies a minimum number of views, and the documented number of views meets or exceeds that minimum, you should only report that "minimum" code until you reach the threshold of the next number of views required.

Therefore, for three shoulder views in this scenario, you should only report code 73030, since the three views performed meets or exceeds the two-view minimum that the code requires, says Stacie Norris, MBA, CPC, CCS-P, director of coding quality assurance with Zotec Partners in Durham, N.C.

CMS specifically addresses this exact scenario in Chapter IX of its 2017 National Correct Coding Initiative Policy Manual for Medicare Services, which reads, "CPT® code descriptors that specify a minimum number of views include additional views if there is no more comprehensive code specifically including the additional views."