Tip: Repeating a procedure or service doesn't always mean extra pay. With football and soccer seasons in full swing, family physicians could be seeing more patients -- young and old -- with upper or lower limb fractures. You'll often need modifiers to accurately report X-ray services, so check two important areas to keep a clear view of fractures coding. Confirm 50 or RT/LT for Bilateral X-rays Physicians often request X-rays for both limbs so they can compare the patient's anatomy or rule out multiple injuries (such as when the patient was involved in a traffic accident). In these cases, you'll report the appropriate X-ray code with modifiers appended to indicate the physician completed bilateral X-rays of the same body part. Example: "It is more appropriate to use RT (Right side) and LT (Left side) when reporting X-rays," says Heidi Stout, BA, CPC, COSC, PCS, CCS-P, Coder on Call, Inc., Milltown, New Jersey and orthopedic coding division director, The Coding Network, LLC, Beverly Hills, Cal. "The specific modifiers help payers differentiate between multiple views of the same area versus bilateral views for comparison." Tip: "Taking X-rays for comparison is up to the provider as part of the evaluation and management of the patient's condition," says Denise Paige, CPC, COSC, with Bright Health Physicians in Whittier, Cal. If the physician orders X-rays of an unaffected area for comparison reasons, link the X-ray code with diagnosis V72.5 (Radiological examination, not elsewhere classified). "Using this diagnosis code may result in a denial from the carrier, but it's correct coding," Paige says. Payment: Remember 76 for Repeated Procedure If the physician completes the same procedure for the patient twice in one day, remember to append modifier 76 (Repeat procedure or service by same physician or other qualified health care professional) to the procedure code. The CPT® description of modifier 76 notes that it "may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service," in which case you append the modifier to the repeated procedure or service. "Modifier 76 is often added for post-reduction films after a fracture reduction in the office or ER," says Bill Mallon, MD, medical director of Triangle Orthopedic Associates in Durham, N.C. Example: Payment: