Orthopedic Coding Alert

Question: An X-ray was taken after manipulation; the surgeon was not happy with the reduction and manipulated again. The post-reduction X-ray was repeated. What modifier can I use as United Healthcare denied the second X-ray?

Texas Subscriber

Answer: You should append 76 (Repeat procedure or service by same physician or other qualified health care professional) when reporting the second X-ray. Confirm with your payer’s guidelines. You may not be paid for the second post-reduction set of films. For example, if your orthopedist does a closed reduction of the elbow by extending, distracting, and then gently flexing to lock the fragment in place, and confirms the same on X-ray, you report 73080 (Radiologic examination, elbow; complete, minimum of 3 views) in addition to 24577 (Closed treatment of humeral condylar fracture, medial or lateral; with manipulation) and you also append modifier 76 to 73080 to specify that the X-ray was repeated by the orthopedist.