Wiki x-ray billing

[mhink693]

We are getting denials for 73562 and 77073 being billed together. It says they can be billed with a 59 modifier on 73562, but would that be correct? or would you just bill 77073 alone as it's doing the entire leg?
thanks!

 

[CBLENNIE]

Are these procedures both being performed on the same side (RT or LT)? If these procedures are being done on the opposite sides of the body, then I think it obvious that both codes should be billed, make sure that in addition to modifier 59 on 73562 you bill the RT or LT modifier and on 77073 bill it with the modifier RT or LT as well. I would also help if there the diagnosis for each procedure, assuming they have different primary DXs if the DX specifies laterality that you code each CPT with the DX that indicates the laterality that matches the RT or LT billed with the CPT code.

If both procedures are being performed on the same limb what is the justification for billing for 73562-xray, knee 3 views, in addition to 77073, which typically includes views of the knee as part of the bone length study of the leg? There is no number or type of views specified for 77073, in general it should include views of the knee if the study is being done on the leg. There is some information available in the NCCI Policy Narrative for 77073 regarding billing for additional x-rays being performed in addition to the 77073.

The NCCI Policy Narratives for 77073 it states the following:


So, the question is, does the additional knee x-ray meet the criteria of being performed to evaluate a different problem and there is a separate and distinct x-ray exam with additional films of the knee? If the answer is yes, then I would say it is appropriate to bill the 73562 w/modifier 59 in addition to the 77073, if the answer is no, then the knee x-ray CPT 73562 should not be billed.