Orthopedic Coding Alert

Question: Our orthopedist performed a three-view ankle x-ray for a left, displaced lateral malleolus fracture in addition to a two-view x-ray for a left, upper-end fibular fracture. It was the first time our practice saw the patient for these injuries. Should I append both diagnosis codes to both procedure codes?

Georgia Subscriber

Answer: In your example, you should not designate both diagnosis codes to both procedures, despite the fact that the fractures are within close proximity to one another. Just as you would if the provider performs the x-rays on entirely separate anatomic sites (e.g., left leg, right leg), you will only apply the diagnosis relevant to each respective scan. This remains true even if the provider images and documents both diagnoses on both x-rays.

For the three-view ankle x-ray of the left, displaced lateral malleolus fracture, you will apply code 73610 (Radiologic examination, ankle; complete, minimum of 3 views). For the two-view x-ray of the left proximal fibular fracture, you will apply code 73590 (Radiologic examination; tibia and fibula, 2 views). If the payer requires it, you might also need to append modifier LT (Left side) to 73610 and 73590.

As for the diagnoses, you will attach S82.62XA (Displaced fracture of lateral malleolus of left fibula, initial encounter for closed fracture) to 73610. You will then attach S82.832A (Other fracture of upper and lower end of left fibula, initial encounter for closed fracture) to code 73590.