Orthopedic Coding Alert

Question: An established patient reports to the orthopedist reporting pain on her right side centered around the hip. After a level-four evaluation and management (E/M) service, the orthopedist performs a three-view hip X-ray. How should I code this encounter? Is the X-ray included in the E/M?

Illinois Subscriber

Answer: You should be able to report the E/M and the X-ray separately. On the claim, you’d report:

• 73502 (Radiologic examination, hip, unilateral, with pelvis when performed; 2-3 views) for the X-ray
• 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity …) for the E/M service.

No modifier 25? Coders might be tempted to append 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 99214 to show that the E/M and X-ray were separate services, but that could be a mistake. Most payers don’t require the modifier when a diagnostic X-ray and office visit are the only services your practice provides a patient in the same session. If you have any doubt, contact the payer — but the prevailing coding convention is to avoid modifier 25 on these X-ray claims.