Radiology Coding Alert

Take advantage of 77071 opportunities for a $47 boost.

You may code a lot of diagnostic X-rays, but are you sure you're appropriately reporting these? The key to accuracy in X-ray coding is the number of views, not the number of films. You also need to append the correct modifiers for bilateral views, distinct services, and repeat procedures.

Count the Views, Identify Location

To help ensure you're reporting X-ray views correctly, scan the procedure note for the number of views ordered and performed to visualize the target anatomy. Where the number of views is not mentioned, you should report the code indicating the lowest number of views.

Consider the elbow: "Simply stating that the X-rays of the elbow were taken and are negative for fracture, is not adequate documentation," says Heidi Stout, BA, CPC, COSC, PCS, CCS-P, of Coder on Call, Inc., Milltown, N.J., and The Coding Network, LLC. "Necessary components of the X-ray interpretation are: indication(s) for examination, anatomic site studies, views taken, description of findings, impression or conclusion."

Example: You will most commonly see anteroposterior (AP) and lateral views of the elbow as these show the joint integrity and help to identify fractures and loose bodies. In a patient who had a fall on an outstretched hand and developed swelling in the elbow, an ordering physician may advise AP and lateral view of the elbow to confirm a nondisplaced medial epicondylar fracture. In this case, you should report 73070 (Radiologic examination, elbow; 2 views).

Careful: Read through the note to avoid missing views. More than one view is usually recommended for all bone and joint radiographs. "Most orthopedists like to see radiographs of any joint taken in two planes 90 degrees opposed to one another, and quite frequently, as in the shoulder or knee, three views are obtained, and occasionally even more," says Bill Mallon, MD, medical director for Triangle Orthopedic Associates in Durham, N.C.

Example: The ordering physician may request an oblique view of the elbow in addition to the AP and lateral views if a fracture of the lateral condyle is suspected. The extra view helps ensure that no fine or faint fracture line is overlooked. In this situation, you report 73080 (Radiologic examination, elbow; complete, minimum of 3 views).

Correctly reporting the number of views will influence your reimbursement. The national Medicare rate for global 73080 (at least three views) is $34.32, but it is $28.54 for 73070 (two views).

Avoid the 'Minimum View' Trap

Reporting the correct number of views requires understanding the phrase "minimum of [number] views" used in many code descriptors.

Example: Code 73110 (Radiologic examination, wrist; complete, minimum of three views) includes the phrase "minimum of three views." If the ordering physician requests three views of a patient's wrist, plus posteroanterior and ulnar deviation wrist views taken at the same session (for a total of five views), you should report only three-view code 73110. You should not additionally report 73100 (Radiologic examination, wrist; 2 views). Code 73110 clearly specifies "minimum of three views," indicating it covers three views or more.

Support: "The CPT® descriptors for many of these services refer to a 'minimum' number of views. If more than the minimum number specified is necessary and no other more specific CPT® code is available, only that service should be reported," states the NCCI Policy Manual, chapter 9.C.1 (available at www.cms.gov/NationalCorrectCodInitEd/).

Add 77071 for Stress View

Although they're rare, don't miss opportunities to report stress views. These are special views taken after the physician subjects the anatomical area to stress and obtains another view to understand the changes, if any, induced by stress.

Example: If the radiologist performs the standard AP/lateral and scaphoid views, as well as ulnar deviated, ulnar oblique, radial deviated, and radial oblique views in a patient, and also interprets the stress view of the wrist, you should report 73110 for the AP, lateral, scaphoid, ulnar deviated, ulnar oblique, radial deviated, and radial oblique views, and also code 77071 (Manual application of stress performed by physician for joint radiography, including contralateral joint if indicated) for the stress view. Medicare's national price for 77071 is $46.89.

Count Views Rather Than Films

Don't make the mistake of assuming views and films are the same thing. You may find two views on a common film, if your office is still using film and computed or digital radiography. In such instances, you should code for the two views.