Billing Multiple Views in Knee X Rays - 73560, 73562, 73564, 73565.

[mmyoung]

Good morning.

I work with an orthopaedic clinic that does in-house imaging. The patient in this instance has unilateral primary osteoarthritis of the left knee. The physician ordered and interpreted essentially four views: both knees in one film (for comparison), and an AP, lateral, and knee-cap sunrise view of the left knee. The insurer is a corporate-run Medicare plan.

Theoretically, we should be able to bill 73562 (3 views) and 73565 (both knees, standing, AP). The NCCI PTP edits for the DOS look like this:

73562 73565 20201001 * * * * * * * 0 Misuse of column two code with column one code
73565 73562 20031001 20200930 1 HCPCS/CPT procedure code definition

My question is: which modifier would be used, and on which code? -ME? -59? -58? -XU? -XS? Nothing seems to fit quite right. I assume the code with the modifier would be 73565. Not billing for the comparison X-ray seems illogical, as it is the medical standard to execute one. Physicians should be paid for all medically necessary services rendered.

Thank you in advanced for your insight.

 

[amyjph]

You can't do those two together according to NCCI. A modifier is not allowed to be appended when trying to report 73562 with 73565.

https://www.aapc.com/blog/23854-coding-diagnostic-views-of-the-knee/

 

[jdavenport02]

If only the symptoms were provided for the left knee, the provider should not be coding or billing anything for the right knee. It is essentially considered a "comparison" study. CPT code would be 73564-LT only. Based off the below information, if the documentation supports the right side, the correct CPT codes would be 73564-LT and 73560-XS-RT. You would not code 73565 at all.

The below information is in Navigator® 2022 Diagnostic Radiology by Revenue Cycle Coding Strategies.

Can I bill for comparison views?
If the referring physician orders an exam of the symptomatic side and the contralateral side is examined for comparison purposes, then only the symptomatic side should be billed. However, if the referring physician orders exams of both side for diagnostic purposes, then both sides should be billed. Each side should be separately documented. See CPT® Assistant (May 2015 and February 2015) and Clinical Examples in Radiology (Winter 2015 and Fall 2008).

 

[amyjph]

If only the symptoms were provided for the left knee, the provider should not be coding or billing anything for the right knee. It is essentially considered a "comparison" study. CPT code would be 73564-LT only. Based off the below information, if the documentation supports the right side, the correct CPT codes would be 73564-LT and 73560-XS-RT. You would not code 73565 at all.

The below information is in Navigator® 2022 Diagnostic Radiology by Revenue Cycle Coding Strategies.

Can I bill for comparison views?
If the referring physician orders an exam of the symptomatic side and the contralateral side is examined for comparison purposes, then only the symptomatic side should be billed. However, if the referring physician orders exams of both side for diagnostic purposes, then both sides should be billed. Each side should be separately documented. See CPT® Assistant (May 2015 and February 2015) and Clinical Examples in Radiology (Winter 2015 and Fall 2008).

Agree.

 

[nolanspade]

Thank you all for providing such great insight for this question - I'm just jumping in to the thread now. I also work for a large Ortho group, and our docs do plenty of bilateral x-rays, and many times there are incidental findings of OA on the comparison side. The patient presents with right knee pain, bilateral x-rays are performed, and the doctor's interpretations says "advanced bilateral osteoarthritis, right greater than left." But, the original, as in the thread, was for right side only. Any thoughts there?

 

[amyjph]

If the reason was comparison and there were no complaints or reason for the study on the opposite side, you still wouldn't bill in my opinion. Even if they found incidental OA. We could do X-Rays of joints on everyone and for most people we would find something....the key is what was the reason for the visit and was there any complaint, treatment, etc. for that XR other than comparison. Was there a diagnostic reason for it otherwise?
Now, if the patient came in for the RT and they do the "oh by the way my other knee hurts too" thing that might be different.

a reference: https://karenzupko.com/billing-for-comparison-views/

Example policy: https://www.bluecrossmn.com/sites/d...adiology Services_General Guides 01.09.18.pdf Comparison X-rayContralateral unaffected body part X-rays taken for comparison purposes are not covered.Repeat X-rays of the same body structure are allowed if performed at different times of day orbefore and after surgery, such as orthopedic procedures including casting.