Part B Insider (Multispecialty) Coding Alert

Question: How should I code the following report? X-rays: I interpreted Rosenberg, lateral, and sunrise views of both knees in the office today demonstrating on the right side a proximal tibial medial osteochondroma. She also has moderately severe osteoarthritis in the patellofemoral joint and the lateral compartment bilaterally. Should we report 73560-RT, 73560-LT, and 73565? Or should we report 73562-RT, 73562-LT?

Answer: Coding experts advise using the second code combination you mention for a standing view of each knee with an additional two views of each knee:

• 73562-LT, Radiologic examination, knee; 3 views; Left side
• 73562-RT, ... Right side.

Here's why: The rationale is that you should report 73565 (Radiologic examination, knee; both knees, standing, anteroposterior) only when the standing views are performed on their own. If the standing views are taken in combination with other views, then you should add the views together and choose your codes based on the total number of views for each knee.

As a result, reporting 73565 with 73560 (Radiologic examination, knee; 1 or 2 views) for each knee would not be your best choice. Instead, you should report 73562 (three views) for each side. The modifiers you use may depend on payer preference. For instance, some may prefer 73562-50 (Bilateral procedure).

Term tip: In this case, you have the following views:

• Rosenberg view of each knee (45-degree flexion, posteroanterior, weight-bearing)
• Lateral view of each knee (side)
• Sunrise view of each knee (patient is prone with the knee flexed).

Diagnoses: The tibial osteochondroma is a benign bone growth reported using 213.7 (Benign neoplasm of long bones of lower limb). For the bilateral knee arthritis, report 715.36 (Osteoarthrosis localized not specified whether primary or secondary involving lower leg).

Under ICD-10, you would look to D16.2- (Benign neoplasm of long bones of ... lower limb) and M17.9 (Osteoarthritis of knee, unspecified).