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Correct Coding for Bilateral Films

JMJJCacch

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Scenario #1: A physician orders bilateral hand x-rays. Our radiology tech performs AP, lateral and oblique of both hands on the same set of films. That's three films total.

Scenario #2: A physician orders bilateral knee x-rays. Our radiology tech performs AP, sunrise, and standing PA flex views of both knees on the same films in addition to lateral views on individual knees. That's a total of five films.

Coding Question: Because there are no appropriate "bilateral" hand or knee codes available, I would like confirmation as to whether or not it is correct coding to bill individual films for each of these. That means, for the hand scenario we would be billing for 6 films but only actually producing 3 films, and for the knee scenario, we would be billing for 8 films when only actually producing 5 films. We own our own equipment and employ a full-time radiology tech. Therefore, we bill for the global service (both technical and professional components). My hesitation in billing for the extra views is that each code includes work RVUs for the tech and the provider. Is it correct coding/reimbursement to bill and be reimbursed for the increased technical component, or am I thinking into this way too much?
 

JMJJCacch

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I understand that they are views and not films, however, we are not producing these "views" on seperate "films" and we do currently bill with the LT and RT just as you suggested. But, how do you justify billing the increased services?

Example: Patient comes in today, has 3 views of the right knee, and we bill 73562. Patient comes in next week, has 3 views of the left knee, and we bill 73562. We are billing for 6 views/films and performing the same. If the patient comes in and has bilateral knee x-rays on the same day, we only perform 3 views/films and yet are billing for 6 views with the LT and RT as you suggested. That's what concerns me.
 

jmcpolin

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so if I understand right you are saying that you have a total of 6 views, but you only have 3 per knee AP sunrise and standing is that right?
 

OCD_coder

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I know what your saying here. It is confusing when you can put views of both hands or knees on an individual picture/film and it looks like your double dipping. But the way the CPT codes read and can be billed are thus:

Hands:
Views - AP, lateral and oblique = 3 views of each hand so it is correct to bill 73130-LT and 73130-RT

Knee:
You have to really look at the CPT codes here and focus on what's being done as there are a few bilateral radiology codes such as 73520 and 73565 for examples to look up.

View: bilateral knee, AP view, standing = 73565
View: sunrise, and standing PA plus lateral = 3 views total of each knee and billed correctly with 73562-LT and 73562-RT

It's absolutely ok to put more than one body area on a picture/film. Based on the CPT descriptions you bill the views, not by film number. It's still work to set up each body area to collect a picture.

Hope that helps.
 
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