Orthopedic Coding Alert

Question: Prior to our patients undergoing a total knee replacement, the doctors like to take a 17-inch-by-36-inch x-ray of the lower extremity to include the hip and knee (joints). How do you code this?

Margo Tingle, Orthopedics
Pacific Sports Medicine, Tacoma, Wash.

Answer: Experts disagree on how to code this. Catherine Brink, CMM, CPC, president of Healthcare Resource Management in Spring Lake, N.J., points out that CPT 2000 does not include a code for a single x-ray that encompasses the knee and hip. And because the medical necessity that demands an x-ray is the total knee replacement, the code selected should be one that applies to the knee.

Brink says that 73650 (radiologic examination; calcaneus, minimum of two views) can be used with a -22 modifier (unusual procedural services). The -22 modifier is used to alert the payer to the extent of the radiological examination made with a single film. She assumes the readers question arises because the practice is charging more for the large, single x-ray than it would for one of the knee alone. (Things change if that is not the case. If they are not charging any more, they should not use the -22 modifier because they are really doing an x-ray of the knee [and charging only for that].)

Brink also says to check with major payers to make certain they recognize and pay -22 modifier claims. She recommends contacting the same payers to tell them what the physician is doing, what it involves, how you are coding, and to ask if there will be a problem with reimbursement.

Note: For more on the successful use of -22 modifier, see Avoid Upcoding or Downcoding: Read the Entire Operative Report on page 35 the May 1999 Orthopedic Coding Alert.

Blair C. Filler, MD, FACS, director of medical education at Los Angeles Orthopedic Hospital and chairman of the committee on CPT and ICD-9 coding at the American Academy of Orthopedic Surgeons, says he prefers to use the unlisted code for a single leg x-ray, 76499 (unlisted diagnostic radiologic procedure), which would also require the submission of the operative report.