Radiology Coding Alert
Is Modifier 59 Necessary for Reporting 72100 and 72148 on the Same DOS?
Question: A 55-year-old patient presented to our urgent care clinic with severe lower back pain after shoveling wet, heavy snow from their driveway and sidewalk. The physician ordered two-view X-rays of the patient’s lumbar spine. After reviewing the results of the X-rays, the physician ordered an MRI of the patient’s lumbar spine without contrast. Following review of the MRI images, the physician diagnosed the patient with a herniated disc between L2 and L3. How would I report the imaging tests for this encounter? Wisconsin Subscriber Answer: You’ll need to report two separate CPT® codes for the encounter you described. You’ll assign 72100 (Radiologic examination, spine, lumbosacral; 2 or 3 views) to report the two-view X-rays of the patient’s lumbar spine. Then, you’ll assign 72148 (Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material) to report the magnetic resonance imaging (MRI) without contrast of the patient’s lumbar spine. Since there is no National Correct Coding Initiative (NCCI) edit for this code pair, you won’t need to append a modifier, such as 59 (Distinct procedural service), to either of the procedure codes. Don’t forget the diagnosis: A herniated disc is another term for the displacement of an intervertebral disc. You’ll assign M51.26 (Other intervertebral disc displacement, lumbar region) to report the herniated disc diagnosis. The 5th characters of the M51.2- (Other thoracic, thoracolumbar and lumbosacral intervertebral disc displacement) subcategory specify which spinal region is experiencing the disc displacement. In this case, the 5th character “6” indicates the lumbar region.
Related Articles
Radiology Coding Alert
- Case Study:
Compare and Contrast This Abdominal Tumor Imaging Report
Do CT abdomen and pelvis scans need 1 or 2 codes? Find out. Providers often [...] - Documentation:
Use These 3 Tips to Strengthen Your Medical Record Keeping Practices
Promote accountability to keep your staff consistent. Cutting corners in your clinical documentation may appear [...] - ICD-10-CM:
Snow Doubt About It — Time to Refresh Your Winter Injury Coding Skills
Remember that 7th character A stands for active treatment. From the slopes to the trails, [...] - You Be the Coder:
Learn How to Report Fluoroscopy That Extends Past 1 Hour
Question: I have documentation that indicates the provider performed fluoroscopy for 1 hour and 30 minutes. [...] - Reader Questions:
Mind Modifier Use When Reporting KUB Ultrasounds
Question: Our radiology practice recently joined a larger medical group. As a result, we’ve transitioned to [...] - Reader Questions:
Know to Assign 76999 for a Ductus Venosus Doppler Study
Question: I have a report documenting the radiologist performed a ductus venosus doppler study only to [...] - Reader Questions:
Is Modifier 59 Necessary for Reporting 72100 and 72148 on the Same DOS?
Question: A 55-year-old patient presented to our urgent care clinic with severe lower back pain after [...]
