Podiatry Coding & Billing Alert

X-rays:

Grasp Foot and Toe Modifiers for Legitimate X-Ray Compensation

Published on Fri Feb 16, 2024

Understanding the different modifiers is key to claim success.

When a patient comes to your podiatry clinic requiring X-rays, the incorrect use of modifiers could lead to your claim being rejected. Therefore, it’s crucial to have a clear understanding of how to correctly assign modifiers when necessary. Read on for tips to correctly code claims involving X-rays and modifiers in your podiatry practice.

Tip 1: Review These Common Podiatry X-Ray Codes and NCCI Edits

The most common X-ray procedures podiatrists perform are:

73600 (Radiologic examination, ankle; 2 views)
73610 (... complete, minimum of 3 views)
73620 (Radiologic examination, foot; 2 views)
73630 (... complete, minimum of 3 views)
73650 (Radiologic examination; calcaneus, minimum of 2 views)
73660 (... toe(s), minimum of 2 views)

Podiatrists most commonly use codes 73620 and 73630. Unlike what you find with many other CPT^® codes, radiology codes aren’t bundled with any other non-radiology procedures. But there is a National Correct Coding Initiative (NCCI) edit that affects them: You cannot bill 73620 with 73660 because an X-ray of the toe will show up on the X-ray of the foot.

However, the edits have a status indicator of 1, meaning they can be unbundled in certain situations.

How it works: All procedure-to-procedure (PTP) edits consist of code pairs arranged by Column 1 and Column 2. A status indicator of 1 allows the additional payment of the Column 2 code if performed on the same day on the same patient by the same provider as the code listed in Column 1. To break this edit, you must append an appropriate NCCI-approved modifier.

For instance, if a patient is experiencing pain in both heels with toe pain and your podiatrist suspects a toe fracture, an anteroposterior (AP) X-ray of the toe followed by a lateral X-ray of both feet can confirm a diagnosis of plantar fasciitis. In this case, you would bill 73620 and 73650. Fortunately, 73620 and 73650 are not subject to NCCI PTP edits, and so “73620 may be performed on the same day as a 73650,” according to Ruby Woodward, BSN, CPC, CPMA, CDEO, CPCO, CPB, COSC, CSFAC, CPC-I, coding educator.

Remember this: “It is also important to be aware that the NCCI guidelines do not allow for reporting of 73630 with 73650 or 73660 on the same date of service,” says Woodward. That means that the only time these can be billed are if they are performed on opposite feet.

Tip 2: Know When to Bill Bilaterally

In the context of billing for X-rays, podiatrists often wonder if they should use modifiers RT (Right side), LT (Left side), or 50 (Bilateral procedure) for bilateral X-rays. In fact, the majority of insurance providers will accept either one code with modifier 50 attached for bilateral claims, or two separate codes each with the LT and RT modifiers.

To indicate which foot you are referring to on a Medicare claim, you can only append modifiers LT and RT to X-rays, or if it’s a toe X-ray, one of the toe modifiers, such as T3 (Left foot, fourth digit). Some private carriers may require modifier 50, so you should always check with your payers to see what they prefer. “When performing imaging of the toes, it is advised to append the T modifiers and not the RT and LT. Many of the payors are denying the LT/RT modifiers for toe services/procedures,” says Woodward.

You should also avoid billing an X-ray with modifier 50 and two units of service. Coding this way is technically billing for four units — not for a right and left foot.

Remember: Never append modifiers LT or RT in conjunction with a toe modifier because the toe modifier already indicates which foot the toe is on.

Woodward gives us two examples below to better illustrate when to use toe modifiers versus when to use a foot modifier:

Example 1: A patient presents after having caught their fifth toe on the bedpost several days ago and is complaining of pain and discoloration in the fourth and fifth toes. The podiatrist orders an AP and lateral X-ray of the fourth and fifth toes of the left foot. This would be reported as 73660-T3, T4 on one line with one unit. Note that 73660 includes the word “toe(s)” plural; thus, it is not reported separately for each toe imaged.

Example 2: The patient presents with complaints of bilateral forefoot pain. The podiatrist orders bilateral weight-bearing AP, lateral and oblique views of both feet. In this instance we would report 73630-RT on one line and 73630-LT on the second line each with 1 unit.

Tip 3: Understand When to Use Technical or Professional Components

At times, separate individuals may carry out and assess X-rays. For instance, if a radiologist conducts the X-ray but does not interpret it, they should only charge for the technical aspect of the X-ray, billing the appropriate code and appending the TC (Technical component…) modifier. If your podiatrist reads and interprets the X-ray, they will then bill the professional component of the X-ray by appending modifier 26 (Professional component). However, if your podiatry office takes its own X-rays, you cannot unbundle the X-ray code and bill the components separately.

“In this instance, you would report the appropriate X-ray procedure and your laterality modifier only,” says Woodward.