Orthopedic Coding Alert

Question: For an x-ray that included three shoulder views, our coder reported 73020 (one view) with modifier 59 appended and 73030 (two views minimum) to cover all three views. Is this accurate?

Arkansas Subscriber

Answer: No. The minimum view requirement is the key to selecting the most appropriate x-ray code.

Do this: You should report 73030 (Radiologic examination, shoulder; complete, minimum of 2 views), because three views meets or exceeds the two-view minimum the code requires.

Wrong way:  Trying to report three shoulder views with 73020 with modifier 59 (Distinct procedural service) appended for one view and 73030 to report the other two views is not correct.

Rule: The CMS National Correct Coding Policy Manual, Chapter 9, explains that "CPT^® code descriptors which specify a minimum number of views should be reported when the minimum number of views or if more than the minimum number of views must be obtained in order to satisfactorily complete the radiographic study. For example, if three views of the shoulder are obtained, CPT^® code 73030, one unit of service, should be reported, not 73020 and 73030."

Translation: When you have a code that specifies a minimum number of views, and the documented number of views meets or exceeds that minimum, you should only report that "minimum" code.