Radiology Coding Alert

Question: A patient presented to our orthopedic practice for follow-up care of their closed fracture in the humeral condyle in their elbow. An orthopedic surgeon performed a manipulation for the closed fracture the week before. During the follow-up visit, the radiologist captured three views of the patient’s elbow. The surgeon was not satisfied with the reduction, so they performed a second manipulation. After the second manipulation, the radiologist captured three more post-reduction X-rays.

How should we report the multiple X-ray procedures? Does the second set of X-rays need a modifier?

Codify Subscriber

Answer: You should assign two instances of 73080 (Radiologic examination, elbow; complete, minimum of 3 views) to report the X-ray procedures. However, you should check with your individual payer’s guidelines to see how they will want the second 73080 code reported.

Your best bet would be to append the second X-ray code with modifier 76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional). Modifier 76 helps you specify that the radiologist performed a repeat X-ray procedure.

Additionally, if you’re also coding for the treatment, you’ll assign 24577 (Closed treatment of humeral condylar fracture, medial or lateral; with manipulation) to report the closed reduction of the patient’s closed elbow fracture.