Radiology Coding Alert

Question: The same radiologist read exams described by 73020 and 73030 an hour apart. May I use modifier 59 or should I only report 73030?

Massachusetts Subscriber

Answer: To use modifier 59 (Distinct procedural service), the services must be performed at different sessions (as yours appears to be), different anatomical sites, and/or through different incisions, experts say.

If the films are from separate encounters, treat them as separate exams. For example, if the patient had a complete shoulder exam during an ED visit in the morning, and a single-view exam in the afternoon after treatment of a fracture or dislocation, that would qualify as two exams. The radiologist should dictate the findings in two separate reports (or, at a minimum, two separate sections of the same report).

Caution: Check to be sure your documentation supports the medical necessity and orders for reporting both 73020 (Radiologic examination, shoulder; one view) and 73030 (... complete, minimum of two views) on the same date of service.

Always append modifier 59 to the less extensive code. In this case, that would be 73020.

The OIG has published a report on misuse of modifier 59, available at www.oig.hhs.gov/oei/reports/oei-03-02-00771.pdf. CMS also has an article with examples available at www.cms.hhs.gov/NationalCorrectCodInitEd/Downloads/modifier59.pdf.