Radiology Coding Alert

Question: In a single session, we performed standing AP, lateral, and tangential views of the left knee and 2 views of the right elbow. For the knee, the documentation shows "left knee pain" that "may be due to patellofemoral joint osteoarthritis or Baker's cyst ... may have ACL deficit knee." The elbow exam shows "right elbow joint osteoarthritis" and "right cubital tunnel syndrome." How should we code these X-rays?

North Carolina Subscriber

Answer: For the standing AP, lateral, and tangential knee views, you should report 73562 (Radiologic examination, knee; 3 views). You also may need to append modifier LT (Left side) to 73562, depending on payer policy.

AP is short for anteroposterior, which is a front view of the knee. A lateral view images the side of the knee. There are a variety of techniques for getting a tangential view, but the goal is to produce an image similar to the sun (the knee cap) coming up over the horizon. That's why this view is also called a sunrise view.

Link 719.46 (Pain in joint involving lower leg) to 73562. The other knee conditions mentioned in the documentation are not confirmed, so you should code the symptom that led to the ordering of the test. (See "Confirmed Diagnosis Trumps Symptoms" on page 54 for more on proper coding when a condition is not confirmed.)

Elbow: Code 73070 (Radiologic examination, elbow; 2 views) is appropriate for the elbow X-ray. You may need to append modifier RT (Right side), depending on payer preference.

The diagnoses you should link to 73070 are 715.32 (Osteoarthrosis localized not specified whether primary or secondary involving upper arm) for the osteoarthritis and 354.2 (Lesion of ulnar nerve) for the cubital tunnel syndrome.

ICD-10-CM: The documentation specifies left and right, which is a good start for meeting the increased documentation needs of ICD-10. The new code set, expected to be implemented in 2014, includes M25.562 (Pain in left knee) and G56.21 (Lesion of ulnar nerve, right upper limb). For the arthritis, the current documentation may support only an unspecified code, such as M19.90 (Unspecified osteoarthritis, unspecified site). To choose a more specific code, you'd need to know whether the arthritis is primary or secondary, which isn't always available in radiology reports.