Radiology Coding Alert

Question: Our radiologist was approached by a patient with an existing chronic subluxation with scoliosis for the past two years. The last X-ray was taken 18 months back and demonstrates subluxation. The patient does not want another X-ray. Will this X-ray suffice for a claim?

Texas Subscriber

Answer:  You physician may choose to use an X-ray to demonstrate the current state of the subluxation. For clinical purposes, the X-ray should have been typically taken within 12 months prior or 3 months following the initiation of treatment. However, in cases such as these, an older record may be accepted if the patient’s health record documents that the patient’s condition has been there for longer than 12 months and there is convincing evidence that the condition is permanent. In such a case, the previous CT or MRI may also be accepted if the subluxation of spine is demonstrated per Medicare guidelines. Check with your payer if they do not follow Medicare guidelines