Resolve Five Perplexing X-Ray Studies
Published on Mon Oct 01, 2001
A number of x-ray studies sometimes furrow a coder's brow -- especially when two or more body parts are imaged during the same session. The following are five common studies that cause coding problems:
1. Unilateral Hip and Bilateral Hips
2. X-rays of Ribs and Chest
3. Joint Survey
4. X-rays of Hands, Fingers
5. Knees
1. Unilateral Hip and Bilateral Hips. Language in code descriptions for radiological examinations of the hips sometimes confuses coders.
CPT provides two clear-cut codes for unilateral studies, says Michelle Juette, CPC, RCC, business services manager for Yakima Valley Radiology in Yakima, Wash.: 73500 (radiologic examination, hip, unilateral; one view) and 73510 (... complete, minimum of two views). Likewise, coding a bilateral study involving only one view of each hip is equally uncomplicated. "The coder would report 73500 twice with the bilateral modifier -- either modifier -50 (bilateral procedure) or the -RT/-LT indicator, depending on payer guidelines," Juette says.
Less straightforward, however, is the code for another bilateral exam, CPT 73520 (radiologic examination, hips, bilateral, minimum of two views of each hip, including anteroposterior view of pelvis). "The reference to an AP view of the pelvis raises the question of how to code bilateral x-rays with multiple views," she points out. In many instances, coders assume that the original physician's order or the radiology report must indicate that a separate AP pelvis was obtained and documented, in addition to two or more views of both hips.
But this isn't the case. When x-raying hips, technicians routinely obtain an AP view of the pelvis along with views of the hip (i.e., lateral, side). The language in 73520 reflects this common practice, but performing a discrete AP pelvis when bilateral views of the hips are obtained is not required. Therefore, 73520 is appropriately reported for any bilateral hip study with two or more views.
Because 73520 has caused problems, clarification of the code through the CPT channels has been requested. Modifications for CPT 2002 are already nearing completion, and any change in 73520 is not expected until 2003.
2. X-rays of Ribs and Chest. Much like hips and pelvis x-rays, coders are confused occasionally with ribs and chest studies because they encompass the same portion of the body. "They are distinct, however," explains Linda Lane, CPC, director of patient accounts for University Radiology Associates of Cincinnati Inc., in Ohio. "Most chest x-rays will be studies of the soft tissues within the rib cage, while x-rays of the ribs focus on the bony structures." The majority of rib studies will be ordered due to chest pain [...]
