Wiki x-ray medical necessity

[nina_930]

A hip x-ray was performed and a diagnosis obtained. However, in the chief complaint and the HPI there is only mention of the patient's knee. Is this a medical necessity issue? The patient technically came in for his knee so is the x-ray of the hip allowed to be billed? Thank you.

 

[thomas7331]

A hip x-ray was performed and a diagnosis obtained. However, in the chief complaint and the HPI there is only mention of the patient's knee. Is this a medical necessity issue? The patient technically came in for his knee so is the x-ray of the hip allowed to be billed? Thank you.

Joint pain can be related to issues in other parts of the body - the provider may have wanted to evaluate the hip to see if the patient is compensating for something that would result in knee paid, so really a question of medical necessity would need to be directed to the clinician. It would really only be an issue from the coding and payment standpoint if the payer has a policy that won't pay for this service for that diagnosis.