Radiology Coding Alert

Question: With an intention to confirm the status of the implant and check the condition of the knee joint, the physician ordered knee x-rays and also specified views to be performed in a patient who had previously undergone a right total knee replacement. The radiography request specified “right lateral, standing PA bilateral knees @45 degree flexion, AP weight bearing bilateral one film, and skyline patella bilateral views of the knee x-ray.” Can we bill bilateral knees, i.e. 73564-RT and 73562-LT?

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Answer: From a coding perspective, you are correct to choose 73564 (Radiologic examination, knee; complete, 4 or more views)-RT and 73562 (Radiologic examination, knee; 3 views)-LT. However, from the description here, it is evident that the diagnosis is specific to the right knee and that the left knee views are for comparison. You’ll need to check payer policy for comparison view reimbursement. Most payers do not consider comparison views medically necessary or will consider them medically necessary in limited circumstances.