Orthopedic Coding Alert

Question: After reading the December 2002 article regarding the Level II site modifiers (-FA, -F1 through -F9) for finger surgeries, we started using them right away. We aren't sure, however, whether we can use the finger modifiers for our x-rays. Someone told us that these modifiers are for surgery only and don't apply to radiology services. Is this accurate? New Hampshire Subscriber Answer: CMS does not specifically dictate whether you should append the finger modifiers to radiology codes, but many Medicare carriers advise that you use them to designate the anatomic site of the radiograph. For instance, Veritus Medicare's (the Part Aprovider in Pennsylvania) "Clarification of Modifier Usage in Reporting Outpatient Hospital Services" policy states that the Level II modifiers (also called HCPCS modifiers) "may be applied to surgical, radiology, and other diagnostic procedures. Use any applicable modifier where appropriate."

Empire Medicare, the Part B provider for New York and New Jersey, offers its policy "Special Guidelines for Using Modifiers with Radiology Services," which directs coders to append Level II modifiers "as appropriate, primarily to codes for procedures performed on fingers, toes or arteries."

Therefore, in the absence of strict carrier advice to the contrary, you should use these modifiers to differentiate between anatomic sites. You should note, however, that 73140 (Radiologic examination, finger[s], minimum of two views) requires at least two views. If you perform two views of the left thumb and two views of the left second finger, you should still report only one unit of 73140 because it refers to two or more finger views. Therefore, the finger modifiers probably will not affect your finger x-ray reimbursement. You Be the Coder and Reader Questions were reviewed by Heidi Stout, CPC, CCS-P, coding and reimbursement manager, University Orthopaedic Associates, New Brunswick, N.J.