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Primary Care Coding Alert

Reader Question:

Don't Subject Your Radiology Codes to Modifier -50

Published on Fri Apr 23, 2004

Question: My family physician (FP) takes an in-office bilateral knee x-ray. Should I report 73562 with modifier  -50 and one unit and double the price? If not, how should we bill the x-ray?

Tennessee Subscriber

Answer: You usually shouldn't use modifier -50 (Bilateral procedure) for reporting bilateral radiology exams. Medicare doesn't subject 73562 (Radiologic examination, knee; three views) to bilateral procedure payment rules, which pay certain bilateral procedures at 150 percent. You should instead list the appropriate radiology code twice on the claim form. For instance, if your FP takes three views of each knee, you should report: 

  • 73562
  • 73562.

    That said, some payers may require you to attach body-side modifiers (-LT, Left side; and -RT, Right side). In this case, you would report:

  • 73562-LT
  • 73562-RT.

    Other insurers may require you to report the appropriate code once with a "2" in the units-of-service field on the claim form. For these payers, you would report:

  • 73562 x 2.

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