ED Coding and Reimbursement Alert

Question: A patient reports to the ED with complaints of sore ribs after crashing his bicycle into another cyclist. After a level-three E/M service, the physician orders and independently interprets a three-view bilateral rib series. The patient had no fractures, only some chest-wall bruising. Do I need modifier 50 for this x-ray series? Idaho Subscriber Answer: You won't need modifier 50 (Bilateral procedure), as the code you-ll use for the rib x-rays indicates that the procedure was done on both sides. On the claim, report the following: - 71110 (Radiologic examination, ribs, bilateral; three views) for the x-rays - modifier 26 (Professional component) linked to 71110 to show that you are not billing for the technical portion of the code - 99283 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; and medical decision making of moderate complexity) for the E/M - modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99283 to show that the E/M and x-rays were separate services - 922.1 (Contusion of trunk; chest wall) appended to 71110 and 99282 to represent the patient's injury - E826.1 (Pedal cycle accident; pedal cyclist) appended to 71110 and 99282 to represent the cause of the patient's injury. -- Reader Questions and You Be the Coder reviewed by Michael A. Granovsky, MD, CPC, FACEP, president of MRSI, an ED coding and billing company in Woburn, Mass.