Radiology Coding Alert

Question: One surgeon regularly orders both hand and finger X-rays (73140, 73120). CCI bundles these codes. May I override the bundle when performed for the same hand?

Codify Member

Answer: Generally, you should not report 73120 (Radiologic examination, hand; 2 views) and 73140 (Radiologic examination, finger[s], minimum of 2 views) together for X-rays on the same hand.

The rationale for the Correct Coding Initiative (CCI) edit is that 73120 is a more extensive procedure than 73140, so you would need to see separate sites or encounters to report the codes for the same date.

Support: According to the NCCI Policy Manual for Medicare Services, the "more extensive procedure" designation indicates that "unless services are performed at separate patient encounters or at separate anatomic sites, the less complex service is included in the more complex service and is not separately reportable." (You may download the manual from www.cms.gov/NationalCorrectCodInitEd/.)

So, for example, if you were reporting 73120 for the right hand and 73140 for fingers on the left hand, you could override the bundle. Depending on your payer's reporting preferences, you may use modifier RT (Right side) with 73120 and modifier LT (Left side) with 73140. You may need to append modifier 59 (Distinct procedural service) to 73140, as well.

As an alternate example, if the patient has a finger X-ray (73140) in the morning, and then the patient's condition changes and the physician orders a hand X-ray (73120) of the same hand, you may report 73120, 73140-59.