Podiatry Coding & Billing Alert

X-rays:

Use Foot, Toe Modifiers to Secure Ethical X-Ray Reimbursement

Published on Fri Mar 19, 2021

Be aware of these NCCI edits before you report 73620 with 73660.

A patient presents to your podiatry office and needs X-rays. If you confuse your modifiers, you could be setting up your claim for a denial. So, make sure you understand what to do in this situation.

Tip 1: Discover Most Common Podiatry X-ray Codes

The most common X-ray procedures podiatrists perform are:

73600 (Radiologic examination, ankle; 2 views)
73610 (... complete, minimum of 3 views)
73620 (Radiologic examination, foot; 2 views)
73630 (... complete, minimum of 3 views)
73650 (Radiologic examination; calcaneus, minimum of 2 views)
73660 (... toe(s), minimum of 2 views)

Podiatrists most commonly use codes 73620 and 73630. Unlike what you find with many other CPT^® codes, radiology codes aren’t bundled with any other non-radiology procedures. But there is, however, a National Correct Coding Initiative (NCCI) edit that affects them: You cannot bill 73620 with 73660, experts say — because an X-ray of the toe will show up on the X-ray of the foot.

However, the edits have a status indicator of “1,” meaning they can qualify to be unbundled in certain situations.

How it works: All procedure-to-procedure (PTP) edits consist of code pairs arranged by Column 1 and Column 2. A status indicator of “1” allows the payment of the Column 2 code if performed on the same day on the same patient by the same provider as the code listed in Column 1. You do have to append an appropriate code to break this edit.

For example, if a patient has heel pain in both feet and your podiatrist suspects the patient has a fractured toe, an AP X-ray of the toe and then a lateral X-ray of both feet can diagnose plantar fasciitis. Modifier 59 (Distinct procedural service) is appropriate in this situation because the podiatrist is taking a bilateral X-ray of the foot and one X-ray of the toe.

Tip 2: Know Whether to Bill Bilateral or Not

When billing X-rays, the question often arises whether a podiatrist should bill bilateral X-rays using modifiers RT (Right side), LT (Left side), or 50 (Bilateral procedure). However, most insurance carriers will accept either for bilateral claims — one code with modifier 50 appended, or two codes with modifiers LT and RT.

To indicate which foot with Medicare, you can only append modifiers LT and RT to X-rays, or if it’s a toe X-ray, one of the toe modifiers, such as T3 (Left foot, fourth digit). Some private carriers may require modifier 50, so you should always check with your payers to see what they prefer.

You should also avoid billing an X-ray with modifier 50 and two units of service. Coding this way is technically billing for four units — not for a right and left foot.

Caution: Never append modifiers LT or RT in conjunction with a toe modifier because the toe modifier already indicates which foot the toe is on.

Tip 3: Parcel Out Technical Versus Professional Components

Sometimes different individuals will perform and evaluate X-rays. For example, if a radiologist takes the X-ray but does not interpret it, he should only bill the technical component of the X-ray using modifier TC (Technical component). Your podiatrist will then read and interpret the X-ray, and he can bill the professional component of the X-ray by appending modifier 26 (Professional component). However, if your podiatry office takes its own X-rays, you cannot unbundle the X-ray code and bill the components separately.

Tip 4: Avoid Confusion With Consultation and Comparison Services

You should never report 76140 (Consultation on X-ray examination made elsewhere, written report) if your podiatrist gives a second opinion of a patient’s films. You should only report this code when a physician requests a second opinion from another physician specifically on an X-ray study, and there is no face-to-face time with the patient. If the review is for a second surgical opinion, you could report the review as an evaluation and management (E/M) consultation or as a second opinion.

On the other hand, a podiatrist may order comparison X-rays to compare a symptomatic foot to a non-symptomatic foot. However, because in this case the comparison involves X-raying a healthy foot, Medicare labels this as a “screening” and will not usually cover the service. Mammograms and colorectal cancer screenings are examples of exceptions to this rule. So, if your podiatrist orders comparison X-rays, be prepared to argue medical necessity.