Radiology Coding Alert

Keep a close eye on views, modifiers, and face-to-face evaluations.

X-rays claims are routine for a radiology coding practice. Here is a refresher for X-ray coding. Say true or false for the 5 statements and judge your understanding of X-ray coding.

Statement 1: You can use modifier 50 (Bilateral procedure) on all bilateral X-ray claims.

Answer 1:  This statement is false. Modifier 50 does not apply to all bilateral x-ray claims. Modifier 50 tells the payer that the provider performed a unilateral procedure (described by a unilateral CPT® code) bilaterally during the same session.

Look for ‘bilateral’ in descriptor: If a code includes the word “bilateral” in the descriptor, you should not add a modifier to show that the test is bilateral.

Example: Code 73521 (Radiologic examination, hips, bilateral, with pelvis when performed; 2 views) includes the word “bilateral” and instructs you that you need two views to use the code. You do not need to append modifier 50 to code 73521 to indicate a bilateral service.

But even knowing this isn’t enough. You should know how to report the appropriate codes and modifiers when you do report a unilateral code bilaterally.

Statement 2: For three shoulder views, one should report 73020-59 (one view) and 73030 (two views minimum) to cover for all three views

Answer 2: This statement is false. The minimum view requirement is the key.

Right way: You report 73030 (Radiologic examination, shoulder; complete, minimum of two views) because three views meets or exceeds the two-view minimum the code requires.

Wrong way: Trying to report three shoulder views with 73020-59 (… one view; distinct procedural service) for one view and 73030 to report the other two views is not correct.

Rule: The CMS National Correct Coding Policy Manual, Chapter 9, explains that “CPT® code descriptors which specify a minimum number of views should be reported when the minimum number of views or if more than the minimum number of views must be obtained in order to satisfactorily complete the radiographic study. For example, if three views of the shoulder are obtained, CPT® code 73030, one unit of service, should be reported, not 73020 and 73030.”

Translation: When you have a code that specifies a minimum number of views, and the documented number of views meets or exceeds that minimum, you should only report that “minimum” code.

Statement 3: For AP and lateral views of whole spine, you can submit code 72082.

Answer 3: This statement is true. For radiological examination of the whole spine, you now have code 72082 (Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed [e.g., scoliosis evaluation]; 2 or 3 views). This is a code introduced in 2016 and replaces the earlier code 72010. The code 72082 spans from the skull to the sacral spine. Because it applies to 2 or 3 views, the AP and lateral views are inclusive.

Statement 4: Your physician interpreted an X-ray for a patient who was evaluated by an orthopedic surgeon. You will consider this patient as “new” for the orthopedist’s E/M service.

Answer 4: This statement is true. You may consider this patient new. Your physician is only interpreting the X-ray. Because interpreting an X-ray is not a face-to-face service, you may consider the patient to be new. You should typically consider a patient “established” if any physician in your group (or, more precisely, any physician of the same specialty billing under the same group number) has seen that patient for a face-to-face service within the past 36 months.

Statement 5: For bilateral X-ray of hips, you need to keep a close count on numbers of views.

Answer 5: This statement is true. CPT® 2016 adds73521 (Radiologic examination, hips, bilateral, with pelvis when performed; 2 views), 73522 (.....3-4 views), 73523 (....... minimum of 5 views) to replace 73520 (Radiologic examination, hips, bilateral, minimum of 2 views of each hip, including anteroposterior view of pelvis) to be specific for numbers of views. You can usethe new codes based on the number of views takento 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 (the large triangular bone at the lower end of the spinal column) and the coccyx or tailbone.