ED Coding and Reimbursement Alert

Question: A patient came into the urgent care following a bicycle accident and the doctor documented that the staff “performed an X-ray for suspected clavicle fracture and examined the AC joint.” The coder initially assumed that only a clavicle X-ray was performed, but our practice manager noticed that the documentation doesn’t say it was only a clavicle X-ray. What should we do?

Pennsylvania Subscriber

Answer: The answer will depend on more specifics from the documentation, but chances are you’ll 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.

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. To make sure the coding is accurate, you should review the medical reports thoroughly, and if the documentation is unclear, go back to the treating physician and ask for clarification.