Radiology Coding Alert

Count views required; ignore number of films obtained.

Coding for plain film radiography of the knee may seem easy but it’s a common source of errors and could be costing you hard-earned pay. Here’s some advice from experts to help you avoid knee X-ray coding error zones.

1. Count the Number of Views

The first step when reporting knee X-rays is to check for the number of views your radiologist obtained. More than one view is usually recommended for all knee radiographs. “Your physician may like to see radiographs of the knee joint taken in two planes, 90 degrees opposed to one another, and quite frequently, three views are obtained, and occasionally even more,” says Dr. Bill Mallon, MD, medical director, Triangle Orthopedic Associates, Durham, N.C.

Depending upon the number of views, you report code 73560 (Radiologic examination, knee; 1 or 2 views), 73562 (Radiologic examination, knee; 3 views), 73564 (Radiologic examination, knee; complete, 4 or more views), or 73565 (Radiologic examination, knee; both knees, standing, anteroposterior). “Codes 73760, 73562, and 73654 are simple codes and you just add up the views of the knee to pick up the most appropriate code,” says Laureen Jandroep, CPC, CPC-H, CPC-I, CMSCS, CHCI, CEO Certification Coaching Organization, LLC CodingCertification.Org, Egg Harbor City, NJ.

Discern Whether Exam’s Complete

The number of views for complete examination varies depending upon the region being investigated. “Typically, the term complete radiological examination means a full examination has been performed of the body area being imaged,” says Christy Hembree, CPC, Team Leader, Summit Radiology Services, Cartersville, GA.

For the knee, a complete view is comprised of 4 or more views of the knee joint, says Laureen Jandroep, CPC, CPC-H, CPC-I, CMSCS, CHCI, CEO Certification Coaching Organization, LLC CodingCertification.Org, Egg Harbor City, NJ. You report code 73654 for a complete radiological examination of the knee. “This CPT® code (73654) not only includes the number of views listed in the code descriptor but typically include any additional views taken as part of that study,” says Hembree.

Note: CPT® necessitates the minimal requirements for knee radiography by the number of views required, not by name of the view. When reporting knee radiography, you can either count the views listed by your physician in the clinical note or have him or her document how many views were performed.

CMS National Correct Coding Policy Manual, Chapter 9 reads: “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.”

2. Don’t Get Sidetracked by Film Type, Digital X-Rays

You may find your radiologist favoring digital X-rays over the conventional plain film X-rays. When compared to the plain film X-rays, digital X-rays are less labor-intensive and can be easily archived for long periods. Also, the fixed dose latitude and non-linear grey scale response in plain film X-rays make them a less favored choice.

Key: CPT® does not distinguish between plain film and digital X-rays. You report codes 73560-73565 irrespective of whether your radiologist obtained a plain film or digital X-rays.

3. Do Not Confuse the Number of Films

You are definitely mistaken if you think that views and films are the same. You may even find two views on a common film, if your radiologist is using film and computed or digital radiography. In such instances, you code for the two views. “CPT® defines x-rays according to the views taken not the number of films,” says Hembree.

Remember: You can separately bill for any bilateral knee views that are imaged together on one film if these are obtained as part of a larger study, provided you have confirmed the medical necessity and a physician order for both sides.

4. Watch When You Report AP View

You report code 73565 when the AP view is performed alone. “CPT® 73565 should not be used for studies involving two or three views of each knee even if one of the views happens to be standing,” says Hembree. “You report code 73565 when it is the only exam done,” adds Jandroep. You should not forget to document the medical rationale for the AP view. However, if your radiologist obtains the AP view along with the other views of one side, right or left, you report the AP view as an additional view. “Code 73656 can be most challenging,” says Jandroep.

Example: You may read that your radiologist obtained a standing AP view X-ray of the knee in addition to the oblique and lateral views, you do not report code 73565. You instead count the standing AP view as a third view and you report code 73562. “When standing views are taken in addition to other views, then you should add the total number of views taken together and report based off the total views of each knee,” says Hembree.

Similarly, if your radiologist obtains the standing AP view as an add-on to a four view study, such as an AP, lateral, and two obliques, you report code 73564. Note that in this situation, the standing AP view is bundled as the code 73564 which includes four or more views. “When the AP standing view is done with other views, then you assign the appropriate code according to number of views per knee. If you do AP standing bilateral along with three additional views of the left knee you would assign 73564-LT and 73560-RT,” says Jandroep.

Caution: Do not confuse standing AP view of the knees should with CPT® code 77073 (Bone length studies [orthoroentgenogram, scanogram]). You report code 77073 for bone length disorders. The code 77073 is not limited to radiographs for bone length assessment but also applies to computed radiography, microdose digital radiography, ultrasonography, CT, and MRI when used for bone length studies.

Example: You may read that your physician attempted a single exposure full-length standing AP radiograph of the lower limbs with the X-ray beam centered at the knee from a distance of approximately 180 cm and placed a lift under one of the legs (the shorter one) to level the iliac crests on both sides. In this case, you report 77073 as your physician is attempting to measure the difference in the limb length on the two sides by obtaining AP views.

5. Check to See if Modifiers Apply

You append modifier 26 (Professional component) to codes 73560-73565 if you are billing for only professional services for your radiologist. Your radiologist may be interpreting the X-ray and not performing the entire procedure. “In order to bill for the professional component (26) the interpreting provider must provide a written and signed report,” says Hembree. Make sure you have the needed documentation. Necessary components of the X-ray interpretation include indication(s) for examination, anatomic site studies, views taken, description of findings, impression or conclusion, says Heidi Stout, BA, CPC, COSC, PCS, CCS-P, Coder on Call, Inc., Milltown, New Jersey and orthopedic coding division director, The Coding Network, LLC, Beverly Hills, CA. “If you are reporting for the total service, i.e., technical plus professional, say for example in a free standing radiology clinic, you do not need any modifier,” says Jandroep.

6. Check the Medical Necessity in Bilateral Views

When your surgeon obtains bilateral views of the knee, you may be able to earn for both, provided your radiologist has documented the medical necessity for the same.

Example: You may be reporting two, three or four views for the right knee and a single view for the left knee. In this case, you can bill single view knee (73560) with 73565 if your radiologist obtains the views as part of a study and documents the medical necessity for the same.

Also note that an exception applies to infants. Unlike the traditional X-ray codes for knee, you report 73592 for each knee when the views are obtained in infants, says Hembree.

Do Not Bill Comparison Views

Often you may find your radiologist requesting an X-ray of the unaffected knee to only enable comparisons. This is not considered as a medical necessity to bill for the X-ray of the normal knee. In this case, you do not bill for the comparison views.