Radiology Coding Alert

Question: Our physician obtained an X-ray after the orthopedic surgeon did manipulation for a closed fracture in the humeral condyle in elbow. The surgeon was not satisfied with the reduction and manipulated again. The post-reduction X-ray was then repeated. Our carrier is United Healthcare. We have been denied the second X-ray. What modifier can we submit for the second post-reduction X-rays?

Texas Subscriber

Answer: You should append 76 (Repeat procedure or service by same physician or other qualified health care professional) when reporting the second X-ray. Confirm with your payer’s guidelines. You may not be paid for the second post-reduction set of films.

Procedure code: From explanation shared by you, if the orthopedist does a closed reduction of the elbow by extending, distracting, and then gently flexing to lock the fragment in place, and confirms the same on X-ray, the orthopedic practice will report code 24577 (Closed treatment of humeral condylar fracture, medial or lateral; with manipulation).

Radiological exam: You report 73080 (Radiologic examination, elbow; complete, minimum of 3 views) and you also append modifier 76 to 73080 to specify that the X-ray was repeated.