Radiology Coding Alert

Question: A patient was referred to our radiology practice following a worksite accident. A piece of metal struck the patient in the face, and their safety goggles broke during the accident. The patient’s general practitioner (GP) ordered X-rays of the patient’s eyes to check for foreign bodies.

Can we report a bilateral foreign body X-ray using 70030?

West Virginia Subscriber

Answer: Yes, you can assign 70030 (Radiologic examination, eye, for detection of foreign body) to report a bilateral foreign body X-ray, but you’ll also need to append it with modifier 50 (Bilateral procedure) to ensure correct coding.

Code 70030’s descriptor doesn’t explicitly state “unilateral,” but you can confirm the code is inherently unilateral by examining the bilateral surgery indicator of “3.” According to Chapter 23 of the Medicare Claims Processing Manual, a bilateral surgery indicator of “3” most likely indicates a radiology procedure or other diagnostic test, which isn’t “subject to the special payment rules for other bilateral procedures.” The “3” indicator means you’ll receive the actual submitted charge for both procedures or 100 percent of the fee schedule amount for each side, whichever charge is lower.

A bilateral surgery indicator of “3” is an indicator that the procedure is considered unilateral if the code isn’t appended with a bilateral modifier. If the documentation and permanently recorded images support that the provider performed the X-ray bilaterally, then you can correctly assign 70030-50 to report the procedure.