X ray Lower Extremity

[Happycoding]

Exam Order states X ray Lower Extremity infant 2 views. but the Age of Patient is Greater than 1 Year sometimes 4 or 5 years old. The technique states Frontal and Lateral Views of Lower Extremity including composite view were obtained. So Is it okay to code 73550 and 73590.

[debsimnz]

You can bill those two codes, but there must be separate reports for each one.

Debby

[mmail]

I agree with Debby and you need the physician order !!!!!

[JTiger115]

Example 1 CPT codes 73592, 73540, 73092 only state infant.
Example 2 in the critical care codes 99291, 99292 has a definition for infant as “ infants 29 days through 71 months”. Then continues to define as “ infant/child qualifies for critical care services during the hospital stay through 71 months of age.” Then in the same section “ neonates (28 days or younger)”

Medicare (CMS) states an infant is 366 days and younger or by the definition of infant as per the insurance payer.

Websters definition of an infant is 12 months or younger.

Online growth charts have infants upto 24 months

Our techs go according to the size of the child because the procedure can capture the body part in one take versus a larger child.

Age could also be incorrect because some children are smaller or larger at certain ages.

Many definitions have been found but unclear inregards to CPT codes.

I emailed AMA and encouraged them to please add a clear definition to these infant codes.

These codes need to be updated because they are unclear and leave room for one's interpretation versus another persons interpretation. It should be clear or remove the word "infant" and in place "limited" or a new modifier???

Maybe we should all email the AMA??

[jgf-CPC]

Most of our denials go by the exact age of the child according to birthdate and not their "size". Sometimes our techs don't have any knowledge of the correct CPT code so we really go by the AMA guidelines in our CPT book.