Coding Diagnostic Views of the Knee

While diagnostic or plain film radiology is usually viewed as “easy” coding, it can confuse some coders and is a source of coding errors and lost revenue.

By Terry Leone, CPC, CPC-P, CIC
I had the privilege during the AAPC national conference in Seattle to co-host the Radiology Specialty Networking session. During that session, there was a discussion regarding the correct coding of plain film views of the knees, which I felt ended with some confusion.
There are numerous diagnostic plain film views of the knees, with an array of names and positions. While learning the various names of the views may be helpful, it is not necessary. CPT® documents the minimal requirements for each study by the number of views required, not by name of the view. As a coder, you can either count the views dictated by your physician or have him or her document how many views were performed.
The standing anteroposterior (AP) view of the knees should not be confused with CPT® code 77073 (Bone length studies [orthorentgenogram, scanogram]), which is performed for leg length disorders. Diagnostic views of the knee are as follows:
73560 Radiologic examination, knee; one or two views
73562 …three views
73564 …complete, four or more views
73565 …both knees, standing, anteroposterior
Note: Modifier 26 would be appended to any of the studies listed above if you are billing for professional services only.
If the standing AP view is performed alone, then you should report code 73565. Medical necessity for one or both of the knees must be demonstrated. If the standing AP view is performed as an additional view and done in conjunction with other views of one side (RT or LT), it is added to the study as an additional view.
For example, if the standing AP view is added to an AP and lateral view (two views), that study becomes a three view study (code 73562). If the standing AP view is added to a four view study, such as an AP, lateral and both obliques, the standing AP is bundled (CCI edits), because code 73564 states that it includes four or more views.
If there is documented medical necessity for both knees, then a single view knee (73560) can be billed when reporting 73565 as part of a study. For example, you could have a two, three or four view right knee, and a one view left knee as long as there is medical necessity for both knees. Remember, any bilateral knee views that are imaged together on one film can be billed separately or as part of a larger study as long as there is medical necessity and a physician order for both sides.
Keep in mind that comparison views are never billed due the lack of medical necessity.
In summary, code 73565 for upright AP views of the knees is coded only if no other views are done for that examination. If additional views are done, the upright AP views of the knees is counted as an additional view of affected knee and code 73565 is not utilized. There are codes for a one/two view study, a three view study and a four or more view study of the knee, as outlined above. Remember, any code utilized should be based on medical necessity and a physician’s order.

6 Responses to “Coding Diagnostic Views of the Knee”

  1. Heather says:

    Our ortho and radiology departments want to bill one 73564 for right and one 73564 for the left, the views showing in the chart are: one front view of both knees, one back view of both knees, a sunrise view of both knees and a lateral view of either one or both knees. Should we bill two 73564 when it states it is 4 views or more? Does the 4 views encompass only unilateral knee or bilateral knees? Thanks!

  2. Heather says:

    Radiology Compliance Question
    When I have an order for knee, three views (73562), and also anteroposterior (AP) standing bilateral (73565), I get rejections. Should this be billed as is with a modifier 59, or should the exams be combined for billing purposes into knee 4+ views (73564). The same question applies when knee, three views bilateral with AP standing bilateral is performed.
    Radiology Compliance Answer
    Code 73565 should be billed when it is the only exam done. When the AP standing view is done with other views, then assign the appropriate code according to number of views. If you do AP standing bilateral along with three additional views of the right knee you would assign 73564-RT and 73560-LT.

  3. Steve says:

    BS paid for 73564 50 but denied 73503 50 invalid modifier? what modifier should I use?

  4. coder 1 says:

    I disagree with using 2 codes, you are to use cpt 73564, for 4 or more views of either knee or both knee.. If pt returns in same day for different complaint on knee, then you use whatever code applies.

  5. Shamika says:

    No modifier will override the bundling rule for 7.564 & 7.565 – They simply cannot be billed together under any circumstance.

  6. Gloria Jimenez says:

    hi, if I have a cpt code 73562 right and left, with same provider how do we cold this claim?