Radiology Coding Alert

Question: I code the professional component for pediatric radiology. What are the correct CPT codes for the following x-rays?

1) bilateral knees, standing, one view, one film showsboth knees from abdomen to ankles

2) bilateral ankles, one view, one film for both ankles.

Florida Subscriber

Answer: The key to both of these scenarios is that you should report the services by view -- not by the number of films.

1) For the first scenario, you should report one unit of 73565 (Radiologic examination, knee; both knees,standing, anteroposterior).

Reason: The tech may be able to fit a small childs entire body on one film, but you should take the order into account when you code. The ordering physician in this case considered a bilateral standing knee exam medically necessary for this patient -- and the radiologist documented this service -- so thats what you should code.

Dont let the radiologists comments on other areas of the lower body tempt you to report additional codes.Standards of practice obligate the doctor to give a quick look at everything in the images. But you should stick to coding the medically necessary (that is, ordered) exam.

2) The second scenario merits 73600 (Radiologic examination, ankle; 2 views). Because you note a single view, you should append modifier 52 (Reduced services). You should report the bilateral service according to your payers preference, such as appending modifiers RT (Right side) and LT (Left side).

In this case, your claim would include:

" 73600-52-RT

" 73600-52-LT.

Caution: If the second ankle was asymptomatic and the x-ray was for comparison only, report a unilateral service.

TC note: If you report only the technical component, payers typically will pay for only one film because your technical costs (work required to take and process images) dont really increase if you put both ankles on the table instead of one.