Pediatric Coding Alert

If you do x-rays in your officeand many pediatricians doyou may have some questions about coding. After all, radiologists only have a small section of CPT to deal with; you have a large number of codes to keep track of.

Mindy Hall, coding clerk for Pocatello Children and Adolescent Clinic, PA, a nine-pediatrician practice in Pocatello, ID, writes to ask about the use of modifiers and x-rays. How do you bill x-rays when you do the x-ray and read it in the office? she writes. Do you use a modifier -26 on all of the x-rays? When do you use a modifier -50 on x-rays? Do you use it when you do two x-rays to compare one to another?

Pediatric practices should bill the x-rays by the appropriate code listed under the radiology section of CPT. The codes are described by location. For example, CPT 73090 is an x-ray of the forearm, with two views: anteroposterior and lateral.

Also, the coder would not use the -26 modifier or the -50 modifier because these codes do not apply when x-rays are performed and read in the office.

Code for Performing and Interpreting X-rays

Since you are performing the x-rays as well as interpreting them, you do not use the modifier -26, explains Charles M. Vanchiere, MD, FAAP, CEO of the Childrens Clinic of SW Louisiana in Lake Charles and chair of the American Academy of Pediatrics RBRVS Project Advisory Committee.

We do x-rays and read them in the clinic, says Vanchiere. I dont use the -26 modifier for the professional component.

There are two components involved here: technical (performing the x-ray) and professional (interpreting the x-ray). If you use the -26 modifier, it will result in payment only being made for the professional component of the service. In addition, the carrier will think you will be sending them a second claim for the second component. If you are just the radiologist, then youd append the -26 modifier to the x-ray code, explains Vanchiere.

Beth Hasson, coding specialist for University Pediatric Surgery Associates of Louisville, KY, agrees. You can only use a -26 modifier if youre reading the x-ray only, says Hasson, whose practice does not read x-rays. All our x-rays are done in the radiology department, she notes.

Use Two of the Same Codes When Comparing Views

You would not use the -50 modifier either. This is an old modifier which is for a bilateral surgical procedure. There is no surgery involved with x-rays.

Vanchiere recommends that if you are doing a comparison view, just use two units of that same x-ray code. For example, if you want to look at the left and right forearms, and one is just for comparison, use 73090 twice. Use the -76 modifier (repeat procedure by the same physician) on the second line. This modifier was created specifically for radiology.