There is a lot of missing information here, but if the documentation is good/complete, and certain conditions are met, then you should be able to charge for both sets of X-rays. The patient should have been a "new" patient/problem with a recent injury that could have caused a fracture, and the clinical/physical findings support this possibility, then a set of "Diagnostic" X-rays would be warranted (Set # 1). If these X-rays did reveal a fracture of sufficient severity (i.e. deformity, angulation, etc.) as to warrant "Active Treatment" in the form of a closed manipulative reduction (even under local anesthesia in the office), following which external splints were applied to maintain the reduction, then a second set of "Post-Reduction" X-rays would be proper to check the post-reduction fracture alignment, and should be chargeable as well. If the fracture alignment based on the Diagnostic X-rays was felt to be acceptable, and no manipulation or reduction was done, and the fracture splinted "as is," then the second set of X-rays were not really warranted as they wouldn't have told the surgeon anything he didn't already know. You would have review the documentation carefully to be certain it can justify the need for both sets of X-rays.
I hope this helps.
Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com