ED Coding and Reimbursement Alert

Question: Encounter notes indicate that ED physician performed a level-four evaluation and management (E/M) service, and then decided to perform a four-view unilateral hip X-ray with stress view. What is stress view, and can I code separately for it?

AAPC Forum Participant

Answer: Yes, you can code separately for the stress view. First, we’ll run down the coding for this claim; then more info on the stress view.

On the claim, report:

• 99284 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity.) for the E/M
• Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) appended to 99284 to show that a significant, separately identifiable E/M service preceded the hip X-ray
• 73503 (Radiologic examination, hip, unilateral, with pelvis when performed; minimum of 4 views) for the X-ray
• Modifier 26 (Professional component) appended to 73503 to show that you aren’t coding for the equipment use, just your provider’s service
• 77071 (Manual application of stress performed by physician or other qualified health care professional for joint radiography, including contralateral joint if indicated) for the stress view

Definition: According to Codify by AAPC, “A radiology technician takes X-ray images of a joint while a physician or other qualified healthcare provider applies stress to hold the joint in a position that the provider could not achieve through routine positioning. These special stress views help the provider gauge the extent of an injury prior to surgery, assess whether an injury is healing without surgery. This service may include imaging of the contralateral joint or joint on the opposite side as necessary.”