Sonda Posted Mon 11th of February, 2019 13:37:37 PM
I have an orthopedic office where they do comparison x-rays often. I shared the CPT assistant from May 2015 concerning CPT code 73565. I’m not an expert in orthopedics so I would greatly appreciate an orthopedic coder's interpretation of the May 2015 CPT Assistant regarding 73565 as well as a professional opinion on when and if this is ever medically necessary to bill 73565 in addition to, for example 73562. Case example: Patient with primary osteoarthritis of left knee presents with pain complaints for many years aggravated with activity. She has fallen several times but none recently. She also notes a lump near the knee. Exam today reveals excellent gait, 0/125 degrees of flexion. She has medial joint line tenderness, some pain with McMurray's testing. She has painless range of motion of the right knee. injected 1cc Kenalog into left knee joint. Imaging x-ray knee bilateral standing; Knee left 3 views. Procedures: 99213-25; 20610-LT 73565; 73562-59 LT (understanding I did not copy the entire record, I'm looking for feedback on the x-ray coding issue only. Diagnosis: Primary osteoarthritis of left knee- M17.12; Patellofemoral disorders, left knee - M22.2X2 and encounter for lower extremity comparison imaging study Z01.89
SuperCoder Answered Tue 12th of February, 2019 08:16:18 AM
Thank you for your Question.
Surgeons sometimes order comparison views of children because they suspect growth-plate injuries and comparing the left side to the right can confirm this type of injury. But in an adult patient, the insurer sometimes considers the non-injured side a screening x-ray because you lack the appropriate diagnosis to justify medical necessity on the healthy leg.
Many insurers and Medicare carriers publish their comparison x-ray guidelines. The National Coverage Determination for Cahaba Government Benefit Administrators (a Part B carrier in Alabama), for instance, states, -Bilateral radiographs, for -comparison- of a symptomatic knee with a patient's asymptomatic knee, are not usually medically necessary in the adult patient.-If your physician believes that he requires the comparison view for medically necessary reasons, you should submit the claims with the LT (Left side) and RT (Right side) modifiers, and include a letter in which the physician describes the medical necessity for the unaffected side. He should link the x-rays to Z01.89 (Encounter for other specified special examinations).
Hope this Helps!
Sonda Posted Wed 13th of February, 2019 13:28:34 PM
To what codes are the RT or LT added to??
SuperCoder Answered Thu 14th of February, 2019 03:31:31 AM
Thank you for your question!
RT and LT modifier would be appended with the Radiological codes provided for the claim. Comparison X ray CPT code would be billable with specific laterality modifier as If one knee has some problem diagnosed then other knee would be billable with other diagnosis code e.g. Z01.89 (Encounter for other specified special examinations) and LT/RT modifier as diagnosis make the difference between both the claim lines.
Hope this Helps!