Radiology Coding Alert

Learn how to correctly report two units of 73600.

Choosing the correct CPT^® code for a radiology procedure is usually straightforward, thanks to the code descriptors that provide the key to knowing which code to assign. But what if you must report two procedures that require the same code?

Find out how to correctly use modifiers to report the same CPT^® code for multiple procedures.

Reporting Multiple X-ray Procedures on the Same Day

Scenario: A 28-year-old patient’s physician refers them to your radiology practice for ankle X-rays. The patient twisted their ankle while walking their dog on an icy sidewalk. The physician orders two procedures — anteroposterior (AP) and lateral views of the right ankle and a bilateral AP view of the ankle — which the radiologist performs on the same day.

CPT^® code lists three codes for ankle X-rays:

• 73600 (Radiologic examination, ankle; 2 views)
• 73610 (…; complete, minimum of 3 views)
• 73615 (…, arthrography, radiological supervision and interpretation)

For the first procedure, you’ll assign CPT^® code 73600, as the radiologist captured two separate views. Selecting the correct code for the second procedure is a little tricky. The request calls out a “bilateral AP view of the ankle,” but the descriptors for 73600 and 73610 list multiple views. In this scenario, your best bet is to assign another instance of 73600, but both uses of the code will require modifiers to ensure proper coding.

Modify Your CPT^® Codes to Tell the Clinical Story

Adding modifiers to your CPT^® codes lets you report or indicate that a provider altered a procedure, but the procedure didn’t change in its definition. Modifiers also allow health care professionals to respond to other entities’ payment policy requirements. In the scenario above, you have two instances of 73600, but each use of the code requires a modifier to accurately depict what happened during the patient’s visit.

With the order of the right ankle X-ray with AP and lateral views, you’ll want to append modifier RT (Right side (used to identify procedures performed on the right side of the body)) to specify laterality.

The second 73600 code, which covers the bilateral AP X-ray of the ankle, will need two modifiers. The descriptor for the code only specifies the number of views, not the laterality, so you’ll need to append the code with modifier 50 (Bilateral Procedure). Additionally, since the order requested a single view of the ankle, you’ll need to use modifier 52 (Reduced Services) to indicate the radiologist captured only one view.

Modifier 76 note: Coding professionals debate the use of modifier 76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional) in a scenario such as this. “Modifier 76 could only be used if the procedure was performed by the same physician on the same day,” says Tanyita Iraldo, CPC, RCC, SR-Certified Coding Specialist of TI’s Coding and Billing Service in Bronx, New York. Modifier 76 is ideal for use where the identical procedure is reported — while the reported codes may be the same, the actual procedures are different, which makes modifier 76 unnecessary.

Pay Attention to Payer Preferences

You should check individual payer guidelines for the correct way to bill in this situation, as it’s possible some private insurance companies and Medicare or Medicaid carriers could deny your claim. If that’s the case, you can consider using an X{EPSU} modifier.

The X{EPSU} modifiers are HCPCS Level II modifiers that Medicare created to provide more specific modifier alternatives to modifier 59 (Distinct Procedural Service).

In the scenario described above, you could append your code with modifier XU (Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service), if the procedures were performed at the same encounter. “If your payer requires the 2nd X-ray to be billed out with RT and LT (Left side (used to identify procedures performed on the left side of the body)) modifiers, you will need the XU modifier on each additional X-ray performed,” says Iraldo.

But for many payers, using 73600-RT to report the AP and lateral X-ray views of the right ankle and 73600-50, -52 to report the bilateral AP X-ray view of the ankle is the correct way to code the visit.