Orthopedic Coding Alert

Question: If we perform a hand and wrist x-ray together, or a foot and ankle together, our insurer denies the claim and states that it won't pay for two adjacent body parts. Is there a way around this?

Indiana Subscriber

Answer: If you are shooting the hand and wrist on one plate (or the ankle and foot on a single plate), you cannot report two separate codes because the single x-ray includes views of both. So if you take only one film, you should bill only one code.
 
If your physician orders separate films and your x-ray technician performs separate shots, most insurers do not bundle together x-ray codes that describe adjacent body sites. For example, the National Correct Coding Initiative does not bundle 73120 (Radiologic examination, hand; two views) and 73100 (Radiologic examination, wrist; two views). Therefore, you shouldn't need a modifier to bill the adjacent site x-rays together.
 
You should contact your insurer and ask why it has been denying your services. One possible reason would be if the insurer has flagged your practice as routinely billing a hand x-ray with every wrist x-ray you perform.
 
Example: If your surgeon orders the two x-rays together as a rule with every upper-extremity diagnosis, you could be overbilling. Make sure your patient has a covered diagnosis before you bill both procedures. For instance, if you report a finger fracture diagnosis, the insurer will want proof of why you performed a wrist  x-ray.