Orthopedic Coding Alert

Question: Encounter notes indicate that the orthopedist performed a level-three evaluation and management (E/M) service for an established patient, 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:

• 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter.) 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 99213 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
• 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.”