Podiatry Coding & Billing Alert

Make sure you know your modifiers when performing follow-up imaging services.

Coding for x-rays can be confusing, and the addition of the FX (X-ray taken using film) modifier for physicians with older forms of imaging devices brings up new questions. X-rays taken after manipulation and casting have occurred, called post-reduction x-rays, are performed to confirm that the bone is aligned properly.

Coding for the additional films taken in an outpatient setting include some additional factors: who the payer is, who performs the images, and the number of images for each stage. Here’s a primer on how to bill for each scenario.

First, a Note on the Potential Additional Modifiers

You’ll also apply the appropriate modifier for the location of the imaged site as necessary, such as RT for right side and LT for left side. For example, for two views of the right foot, you would report 73620-RT (Radiologic examination; foot; 2 views). For toes, use TA and T1-T9, such as 73660-T2 (Radiologic examination; toe[s], minimum of 2 views) for left foot, third digit.

You may report two lower-extremity codes (e.g., 73660 and 73620) only when your FP performs the x-rays on separate feet. Since a same-side foot x-ray will also show the toes, NCCI bundles 73660 into 73620.

Same number of views for pre- and post-reduction, same physician: Code two units of the appropriate code. You’ll append modifier 76 (Repeat procedure or service by same physician or other qualified health care professional) to the second code.

For example: Your doc reads a pre-reduction x-ray of the toe with a minimum of two views (73660) followed by a post-reduction x-ray of the toe with the same number of views. The proper coding is:

• 73660
• 73660-76

Different number of views for pre- and post-reduction, same physician: Separately report the appropriate CPT® code for each x-ray, but for the post-production x-ray code append modifier 59 if the same provider reads both the pre- and post-reduction films.

For example, a provider interprets a pre-reduction x-ray of the foot with a minimum of three views (73630, Radiologic examination, foot; complete, minimum of 3 views), followed by a post-reduction x-ray of the foot with two views (73620). In this case, you would report:

• 73630
• 73620-59

Note: Some Medicaid payers will require you to report the second procedure with modifier 76 when the same provider interprets both films, regardless of the number of views. As always, verify the proper claims coding with your local Medicaid payer before billing.

Different Physician, Regardless of Number of Views

If a different provider reads the post-reduction x-ray and the number of views also changes, you should append modifier 59 to the post-reduction code:

• 73630 for the first physician
• 73620-59 for the second

The coding also changes if the orders are the same pre- and post-reduction and a second provider performs the post-reduction x-ray. Under these circumstances, append modifier 77 (Repeat procedure by another physician or other qualified health care professional) to the post-reduction x-ray code:

• 73630 for the first physician, who reads the pre-reduction x-ray
• 73630-77 for the second physician, who reads the post-reduction x-ray

Note: For more on the FX modifier, see Podiatry Coding Alert, Vol. 9, No. 4.