Radiology Coding Alert

Question: We performed a two-view ankle x-ray before surgery so the physician could confirm a patients fracture site. During the surgery, the physician ordered a three-view study to ensure that he aligned the fracture correctly. Can we report the second study, or will Medicare deny it?

Pennsylvania Subscriber

Answer: Because the physician required a second distinct study to confirm alignment, and the more limited study was not merely a component of a more extensive study, you should report both studies.

You should append modifier -59 (Distinct procedural service) to the first x-ray code. This will tell the insurer that the x-rays were separate and distinct from one another.

Therefore, you should report CPT 73610 (Radiologic examination, ankle; complete, minimum of three views), followed by 73600-59 (Radiologic examination, ankle; two views; distinct procedural service).

Remember that you should always append modifier -59 to the component code, or the code for the service that would be considered bundled, and not necessarily to the first service performed.