I have a supervisor that would like us to code 2 unilateral hip xrays (73500), the second with a modifier rather then bill a bilateral hip xray (73520). I'm thinkng this is not right and there must be a CCI edit out there that will address this. Can someone point me in the right direction? Thank you!
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Wiki Xray Coding Bilateral vs Unilateral
- Thread starter k030876
- Start date
mitchellde
True Blue
the rules are very specific on this if a bilateral procedure is performed and a bilateral code exisits then you use the bilateral code. Fortunately ICD-10 codes will help with this.
mitchellde
True Blue
I read this so long ago, it may be in the McM or it may even be in the CPT book in the intro to the radiology section. Also it could have been in a CPT assistant. I really wish I could remember but it was ages ago. I guess my question is why is she insisting on billing the unilateral as 2 lines? it does not make any sense.
mitchellde
True Blue
I am glad you found it ! Good for you!
kmschwarz
Guest
How was the exam ordered? The code 73520 has to include 2 views of each hip, as well as a single view of the pelvis. I found this on another post from 2009:
Radiology Question
Can code 73520 still be used to report a bilateral hip x-ray performed with two views on each side even if an anteroposterior view of the pelvis is not also performed or is it more appropriate to report code 73510 twice?
AMA Comment
According to the American College of Radiology, an anteroposterior (AP) view of the pelvis, as well as additional views of both hips, is the appropriate method of examination when a bilateral hip study is ordered. In addition to the AP view of the pelvis, at least one more view of each hip, typically a coned-down frog leg lateral view, is obtained amounting to three views: one AP view of the pelvis which includes both hips; one frog-leg lateral of the right hip; and one frog-leg lateral of the left hip.
However, if a bilateral study is performed without an AP view of the pelvis, then code 73520, Radiologic examination, hips, bilateral, minimum of two views of each hip, including anteroposterior view of pelvis, may be reported with modifier -52, Reduced services, appended to indicate that the study was not performed in its entirety. CPT code 73510, Radiologic examination, hip, unilateral; complete, minimum of two views, is not intended to describe a bilateral hip study, but a complete radiological examination with a minimum of two views performed on a single hip.
If right and left hip studies are separately ordered and performed, and there are separate interpretations and written reports signed by the interpreting physician, then it would be appropriate to report the code 73510 two times. In this case, modifier -59, Distinct procedural service, should be appended to the second code to indicate that it is a distinct procedure.
Since modifiers are carrier specific, it is recommended that the provider check with their local carrier and other third-party payers for their guidelines on the use of modifiers.
Radiology Question
Can code 73520 still be used to report a bilateral hip x-ray performed with two views on each side even if an anteroposterior view of the pelvis is not also performed or is it more appropriate to report code 73510 twice?
AMA Comment
According to the American College of Radiology, an anteroposterior (AP) view of the pelvis, as well as additional views of both hips, is the appropriate method of examination when a bilateral hip study is ordered. In addition to the AP view of the pelvis, at least one more view of each hip, typically a coned-down frog leg lateral view, is obtained amounting to three views: one AP view of the pelvis which includes both hips; one frog-leg lateral of the right hip; and one frog-leg lateral of the left hip.
However, if a bilateral study is performed without an AP view of the pelvis, then code 73520, Radiologic examination, hips, bilateral, minimum of two views of each hip, including anteroposterior view of pelvis, may be reported with modifier -52, Reduced services, appended to indicate that the study was not performed in its entirety. CPT code 73510, Radiologic examination, hip, unilateral; complete, minimum of two views, is not intended to describe a bilateral hip study, but a complete radiological examination with a minimum of two views performed on a single hip.
If right and left hip studies are separately ordered and performed, and there are separate interpretations and written reports signed by the interpreting physician, then it would be appropriate to report the code 73510 two times. In this case, modifier -59, Distinct procedural service, should be appended to the second code to indicate that it is a distinct procedure.
Since modifiers are carrier specific, it is recommended that the provider check with their local carrier and other third-party payers for their guidelines on the use of modifiers.