Radiology Coding Alert

Do you remember when a component modifier is applied?

Do you think you correctly identified every answer from our quiz questions on page 3? Check your work to see if your answers match up with the ones provided below.

Choose the Right Chest X-ray Code

Answer 1: You’ll assign 71046 (Radiologic examination, chest; 2 views) to report the two-view chest X-ray. In the scenario, the radiologist captured anteroposterior (AP) and lateral chest X-ray views, but the radiologist did not interpret the results.

You’ll append modifier TC (Technical component …) to 71046 to report that the provider performed only the technical portion of the procedure.

In this scenario, the outpatient imaging center employs the radiologist and owns the X-ray equipment, which means you can bill only for the technical portion of the procedure. Modifier TC covers the imaging center’s services, such as the equipment and staff needed to perform the chest X-rays.

“The TC modifier is used for the technical only portion of a radiologic service which is the equipment, the room, and the personnel actually taking the images,” says Ruby O’Brochta- Woodward, BSN, CPC, CPMA, CDEO, CPCO, CPB, COSC, CSFAC, CPC-I, coding educator.

Lessen Lumbar Spine X-ray Coding Confusion

Answer 2: The scenario presented in the question involved a lumbar spine X-ray for a 65-year-old patient complaining of continued lower back pain. A radiologist in the nearby hospital’s radiology department captured AP, lateral, and bending X-rays, then interpreted the results and compiled their report.

You’ll assign 72100 (Radiologic examination, spine, lumbosacral; 2 or 3 views) to report the three-view lumbar spine X-ray. In this case, you’ll need to append modifier 26 (Professional component) to 72100 to indicate you’re coding for the radiologist’s services. The radiologist’s services include performing the procedure, interpreting the images, and compiling their report.

“Modifier 26 indicates that a CPT® procedure was performed by the provider themself when the equipment was owned by the hospital or facility, or to report the physician’s interpretation of a test,” says Lauren E. Braico, CPC, CEDC, medical coder with Practice Resources LLC in Syracuse, New York. In this case, the hospital will append TC to 72100 since they own the X-ray equipment.

Even though the provider captured images of the patient’s lumbar spine, you’ll still use 72100 to report the procedure. Code 72100’s descriptor includes the lumbosacral region, which covers the lumbar spine and the sacrum. This means that if the provider captures two or three views of the lumbar spine, the sacrum, or both portions, you’d still report 72100.

Scrape Together the Correct Scapula Code

Answer 3: For this scenario, you’ll report only 73010 (Radiologic examination; scapula, complete) without a modifier appended for the orthopedic clinic. This was a tricky scenario, but the radiologist is employed by the outpatient orthopedic clinic, the clinic owns the X-ray equipment, and the radiologist interpreted the results. Therefore, the procedure falls under the complete code for the clinic.

“It’s not uncommon for orthopedic practices to provide on-site X-rays to their patients. In many cases, the surgeon owns the X-ray equipment, pays for a technician to perform and process the X-ray images, and interprets and documents the imaging findings. In this case, the orthopedic surgeon is performing the complete service and will report the imaging study without the 26/TC modifiers,” says Jennifer M. Connell, BA, CPPM, CPCO, CDEO, CPMA, CPB, CRC, COC, CPC, CPC-P, CPC-I, CCC, CCVTC, CEMC, CENTC, CFPC, CGIC, CGSC, CHONC, CUC, ROCC, CEMA, CMCS, CMRS, AAPC Approved Instructor, revenue cycle director of Citizens Medical Professionals in Victoria, Texas.

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