Radiology Coding Alert

Question: Should we append the Level II site modifiers (-FA, -F1 through -F9) when we x-ray a patient's fingers?

Tennessee Subscriber

Answer: CMS does not specifically dictate whether you should append the finger modifiers to radiology codes, but many Medicare carriers advise that you use them to designate the anatomic site of the radiograph.

For instance, Veritus Medicare's (the Part Aprovider in Pennsylvania) "Clarification of Modifier Usage in Reporting Outpatient Hospital Services" policy states that the Level II modifiers (also called HCPCS modifiers) "may be applied to surgical, radiology, and other diagnostic procedures. Use any applicable modifier where appropriate."

Empire Medicare, the Part B provider for New York and New Jersey, offers its policy "Special Guidelines for Using Modifiers with Radiology Services," which directs coders to append Level II modifiers "as appropriate, primarily to codes for procedures performed on fingers, toes or arteries."

Therefore, in the absence of strict carrier advice to the contrary, you should use these modifiers to differentiate among anatomic sites. You should note, however, that 73140 (Radiologic examination, finger[s], minimum of two views) requires at least two views. Consequently, if you perform two views of the left thumb and two views of the left second finger, you should still only report one unit of 73140 because it refers to two or more finger views. Therefore, the finger modifiers probably will not affect your reimbursement for finger x-rays.

The finger modifiers might help prove medical necessity when the Correct Coding Initiative (CCI) edits preclude you from billing two radiology codes together. Section 15068 of the Medicare Carriers Manual advises using HCPCS modifiers "when certain mutually exclusive codes are appropriately furnished, such as later on the same day or on a different digit or limb."

If you have never used the Level II modifiers before, check with your carrier ahead of time to ensure that it recognizes them.