Radiology Coding Alert

Question: Our physician does radiological examination of the wrist and obtains only one view of the wrist. Code 73100 applies for radiological examination comprising two views. How do you suggest we best report this condition? Do we go for an unlisted code or do we append modifier 52?

Ohio Subscriber

Answer: It is not appropriate for you to report radiological examination of wrist in one view as unlisted. You may first try to learn from the radiologist about the number of views. Your physician can document the number of views using an addendum, and you can choose the appropriate code based on that information. If you can’t get a definitive answer on the number of views, then you should report the code representing the lowest number of views. 

Experts note that auditors who review records that don’t document the number of views will down code the service to match the lowest number of views and restrict payment to that level.

For example: If you don’t know the number of views for a wrist x-ray, you should report 73100 (Radiologic examination, wrist; 2 views) rather than the more extensive 73110 (... complete, minimum of 3 views.

In the scenario described by you, your physician obtains one view, so you can append modifier 52 (Reduced services) to code 73100.