Radiology Coding Alert

Views gain precedence in spine, pelvis, hip, and femur X-rays.

X-rays may be one of the routine and frequently reported procedures in your practice. X-rays are a simple and initial commonly used diagnostic modality. It is important for you to keep pace with the latest trends in X-ray reporting. Are you still confused for important changes in CPT^® codes for X-ray examinations introduced this year? Here is how you can make your way to confident coding.

Earn For More Views with New Spinal X-Ray Codes

CPT^® 2016 adds code 72801 for full spine single view, and three successive codes for additional views to replace 72090 (Radiologic examination, spine; scoliosis study, including supine and erect studies). At this time, CPT^® does not provide an indication as to the reason for deletion of this code.

Here are the new code descriptors in detail:

• 72081 – Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (e.g., scoliosis evaluation); one view
• 72082 – … 2 or 3 views
• 72083 – … 4 or 5 views
• 72084 – … minimum of 6 views.

Report 72081 to report a single plain X-ray image of the entire thoracic and lumbar spine taken from a single angle or direction (projection). The single image may include the skull, neck (cervical spine), and tailbone (sacral spine). So, if included, do report a separate code. The procedure is typically performed to evaluate a patient for scoliosis, an abnormal curvature of the spine that is oriented from side to side.

If the provider takes two or three views of the back, use code 72082; for four or five views of the back, use code 72083; and if the provider takes at least six views of the back, use code 72084.

New Codes Apply to Pelvis, Hip, and Femur X-rays

CPT^® 2016 adds codes 73521 (Radiologic examination, hips, bilateral, with pelvis when performed; 2 views), 73522 (…..3-4 views), and 73523 (….. minimum of 5 views) to replace code 73520 (Radiologic examination, hips, bilateral, minimum of 2 views of each hip, including anteroposterior view of pelvis), which was never assigned a Relative Value Scale.

Check number of views: You can use the new codes based on the number of views taken to report plain X-rays of both or bilateral hips, and pelvis if included, from two or more different projections or directions. In this diagnostic procedure, the provider takes two or more X–ray images from different projections (directions or angles) of both hips, left and right, to check for fracture, swelling, or other reason for pain in the hip area. The procedure may include the entire pelvis, which includes the hip bone, the sacrum and the coccyx or tailbone.

New Unilateral Hip X-ray Codes: Amongst the new codes added, we also have 73501(Radiologic examination, hips, unilateral, with pelvis when performed; 1 view), which is a unilateral hip x-ray that includes the pelvis. Now, this is a one view, and it is used to report a single X-ray of one hip, and thus is unilateral. Code 73502 is for a unilateral hip and pelvis with two or three views such as AP and lateral. 73503 is a unilateral hip with the pelvis, including four plus views.

Here are the code descriptors in detail:

• 73501 – Radiologic examination, hips, unilateral, with pelvis when performed; 1 view
• 73502 – Radiologic examination, hip, unilateral, with pelvis when performed; 2-3 views
• 73503 – Radiologic examination, hip, unilateral, with pelvis when performed; minimum of 4 views.

For plain X–rays of the pelvis, see 72170 (Radiologic examination, pelvis; 1 or 2 views) and 72190 (Radiologic examination, pelvis; complete minimum of 3 views). Codes 72170 and 72190 continue to be available for use.

Femur specific codes: In case you just wanted to focus on the femur, we have a couple of new codes for that. CPT^® 2016 adds 73551 (Radiologic examination, femur; 1 view) to report a single X-ray of the femur exclusively, for which there was no previous code. You can use 73551 to report a single plain X-ray of the left or right femur, but not both. Again, this code does not include the pelvis.

In this diagnostic procedure, the provider takes an X–ray image from a single projection (direction or angle) of the femur, or thigh bone, to check for fracture, swelling, or other reason for pain in the thigh area. If the provider examines at least two views of the thigh bone, use code 73552 (Radiologic examination, femur; minimum 2 views).

Strike Out These Deleted Codes from Your Listing

Let’s move on to codes that you can no longer report because they’ve been deleted. Get them out of your billing system and erase them from your superbill.

Table 1 shows a quick list of the obsolete codes. Strike these off your list for 2016 codes. Also listed are new codes that you should include in your list.

Taking a look at the deleted code 72010, a full spine survey with two views, we know that the code for this is the brand new 72082. Next, we move on to 72069, a thoracolumbar standing scoliosis study, and 72090, the scoliosis study, these again are going to be replaced by the additions 72081-84. Further on, needless to say, the table depicts the changes you need to adopt.

Pay Attention to Physician Service and Documentation Details

So, how do you make the most of this new development? Here are a few tips on getting the most out of these changes:

1) If you are reporting only the physician’s interpretation for the radiology service, append modifier 26 (Professional component) to the radiology code.

2) If you are reporting only the technical component for the radiology service, you should append modifier TC (Technical component) to the radiology code unless the hospital provided the technical component. In that case, do not append modifier TC because the hospital’s portion is inherently technical.

3) Moreover, do not append a professional or technical modifier to the radiology code when reporting a global service in which one provider renders both the professional and technical components.

4) Be sure that the provider’s documentation clearly describes each view taken in a radiology service.

5) Check the documentation for the patient’s body position and projection of the X–ray to assign the correct number of views.

Focus on getting these codes right, so that you can reap the benefits of a smooth reimbursement.