Wiki knee xray coding question

[tschrader]

I need clarification on knee X-rays being billed. We seem to go around on this.

Examples of dictation that i am getting before and after corrections:

Example 1:
previous:
X-rays of knee are unmark able. No fracture, degenerative changes or lytic lesion is noted.

Addendum:
Standing AP, lateral merchant, and notch x-rays of with knee with comparison of the left knee.

Codes that are billed:
73562/59RT
73565

Code i feel should be coded: 73564/RT comparison view of left knee is included

Example 2:
Previous:
X-ray of the right knee show a well fixed total knee arthroplasty. There is no significant joint space narrowing or loosening.

Addendum:
Weight bearing AP, lateral, merchant and notch in comparison with AP of both knees.

Codes that are billed:
73560/59RT
73562/LT
73565

Codes i feel that should be billed: 73564/RT and 73564/LT

The doctors do their own coding and feel that this is how it should be billed. Not the way the i have suggested it should be. I also have pulled a documentation off of AAPC that this is how it should be billed.

Any feedback on this would be great!!!

Thanks for your help!!

 

[renoir]

In the Fall 2006 edition of the American College of Radiology Clinical Examples in Radiology coding resource reference discussed the reporting of standing knee xrays. The following excertpted from the article and address a filming scenario provided:

Examples on standing knees, "Note that code 73565 (xray exam both knees, standing, anteroposterior) should be reported when an AP standing xray of both knees is the ONLY STUDY PERFORMED. The three basic codes of the knee (73560:1-2 views, 73562: 3 views, and 73564: 4 or more views) describe all other knee studies. For example, when an AP upright of both knees, plus lateral and skyline views of the right knee are performed, it would not be appropriate to report code 73565. In this scenario, it would be appropriate to code for 73560-LT to describe the one view of the left knee and 73562-RT to describe the three views (AP, upright, lateral, skyline) of the right knee. Using the LT RT modifiers respectively indicates to the payer of the procedures performed on each knee."

Make sure the phyician documents the findings on both knee xrays to support the billing. We have an issue with getting our docs to note the findings on the contralateal knee.

Hope this is helpful. This information was from a webinar presented by Margie Scalley Vaught, 2014 Orthopedic Medicare and Coding Updates.

 

[tschrader]

Thank you so much for your help. I am seeing it all comes down to you cannot bill the 73565 with these other codes. Hopefully this will help with my case.