Radiology Coding Alert

Reader Question:

Read the Descriptor’s Fine Print to Avoid a Denial

Published on Wed Dec 21, 2022

Question: I’m a new coder, and my first claim was denied. I had a report that indicated the radiologist performed shoulder X-rays on a patient and captured AP, PA, and lateral views. I assigned 73020 and 73030 to report the three-view X-ray procedure, but it was denied.

How can I correct this claim?

Georgia Subscriber

Answer: You need only one CPT^® code to report this procedure. The radiologist captured anteroposterior (AP), posteroanterior (PA), and lateral views during the procedure. Combining the single view of 73020 (Radiologic examination, shoulder; 1 view) and the two views of 73030 (Radiologic examination, shoulder; complete, minimum of 2 views) to account for the three total views captured may seem like the correct coding method, but it’s incorrect.

When you examine the descriptor for 73030, you’ll notice the procedure requires a minimum of two views. Therefore, if the radiologist captures more than two views of the patient’s shoulder, 73030 still applies to the procedure.

The 2023 Medicare National Correct Coding Initiative Policy Manual, Chapter IX, Section C.2, states, “CPT^® code descriptors that specify a minimum number of views include additional views if there is no more comprehensive code specifically including the additional views.” This means that if only 73020 existed, then you’d report multiple units of that specific code. However, since 73030 includes two or more views captured, you’ll report just 73030 if the radiologist captured at least two views.