Radiology Coding Alert

Question: I’ve been coding for several years, but I’m new to radiology. I have a report stating the radiologist performed X-rays on a 13-month-old patient. The report states they captured two views of the patient’s ulna and radius bones to check for fractures.

Can you explain the difference between CPT^® codes 73090 and 73092 and tell me which code I should use for this report?

Pennsylvania Subscriber

Answer: Code selection in this situation will depend on your payer’s determination of the patient’s infant status. If the payer’s definition of infant is a child between the ages of 0 and 24 months, you would use 73092 (Radiologic examination; upper extremity, infant, minimum of 2 views). The use of the term “upper extremity” in this code would cover the ulna and radius bones, which are the main long bones of the forearm and the bones called out in the report. The report also indicates the physician captured two views of the arm during the exam, which again makes 73092 an appropriate code for documenting this procedure.

However, if the payer definition of infant is a child between the ages of 0 and 12 months, you would select 73090 (Radiologic examination; forearm, 2 views). Like 73092, this code describes both the anatomic region examined and the number of views. But the omission of the word “infant” would make the code appropriate for a 13-month-old child if the payer definition of infant only extends to a child younger than 1 year.