Neurology & Pain Management Coding Alert

Question: Encounter notes indicate that the provider performed a level-three evaluation and management (E/M) service and a standing X-ray on both knees. How should I code for the X-rays? Should I report a unilateral X-ray code twice; or with modifiers LT/RT; or with modifier 50?

Answer: Don’t report the X-ray in any of the ways you listed. Instead, report 73565 (Radiologic examination, knee; both knees, standing, anteroposterior) for the X-ray.

Explanation: When there is a bilateral code that accurately describes your provider’s service, you should always opt for that code over the less accurate “X-ray code x 2” method; or appending modifier 50 (Bilateral procedure) or modifiers LT (Left side) and RT (Right side) to the X-ray code.

Depending on patient status, you should report either 99203 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 30-44 minutes of total time is spent on the date of the encounter.) or 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter.).

Regardless of patient status, you should apply modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to 99203/99213 to show that a significant, separate E/M preceded the X-ray.