Location Matters on This Spinal Stenosis Claim
Question: The neurosurgeon orders and interprets a cervical spinal X-ray for a patient with neck pain and gait imbalance. After the X-ray, the surgeon notes “cervical spinal stenosis.” How should I report this encounter? Oregon Subscriber Answer: In order to code this encounter properly, you’re going to have to review the notes for more information. First, you’ll need to choose the proper X-ray code. Since the provider didn’t specify how many views were taken, you should check the notes and choose one of the following codes, depending on encounter specifics: Where did it happen? If the provider only interpreted the X-ray and it was performed using another entities’ equipment, append modifier 26 (Professional component) to the X-ray code. So, if the provider ordered a 4-view X-ray using hospital equipment, you’ll report 72050-26. If the surgeon ordered the X-ray and it was performed with the practice’s equipment, you won’t need the modifier. According to Medicare payer Novitas Solutions, the professional component “is outlined as a physician’s service, which may include technician supervision, interpretation of results and a written report. Use modifier 26 when a physician interprets but does not perform the test.” Don’t forget: You should also append M48.02 (Spinal stenosis, cervical region) to the X-ray code in order to indicate the patient’s spinal stenosis. Chris Boucher, MS, CPC, Senior Development Editor, AAPC
