By, Mary LeGrand, RN, MA, CCS-P, CPC, Consultant and Speaker
KarenZupko & Associates, Inc.
Anatomic Modifiers on X-Rays
Do X-Rays codes need side or specific finger and toe modifiers?
This is a great question and may be payor dependent. Some payors may or may not accept the anatomic modifiers, but most practices will use the RT and LT when reporting the same X-Ray for both extremities on the same day. For example, bilateral wrist X-Rays will be reported at 73100 RT and 73110 LT. Survey your payors to determine if the anatomic modifiers are required if only one X-Ray is reported. X-Rays are typically not reported with a modifier 50.
More and more, payors are requiring the Finger Modifiers (FA-F9) when reporting CPT code 73140 Radiologic examination, finger(s), minimum of two views. The parenthetical (s) means that you cannot report the code more than once per extremity. X-Rays of the right first index finger, CPT code 73140 F6 would be submitted on the claim form. The same concept applies to the toes but the “T” modifiers would be reported for the specific toe(s).
In what Facilities can you report J codes?
J codes are used to report drugs purchased by a practice and administered in the Non Facility (physician office where the expense is incurred). Drugs administered in a Facility setting (ASC, Hospital) are not separately reportable by a physician as the Facility reports and is paid for the drugs according to the Facility contracts.
Suspected Scaphoid Fracture
I see a patient with a suspected scaphoid fracture, apply a short arm fiberglass cast and order an MRI. The patient returns 2 weeks later and the fracture is confirmed. What is the proper way to bill this?
On the first day report the appropriate E&M-25, cast application and supplies use the A or Q codes assuming documentation supports all services described. On the return visit when the fracture is confirmed, continue to report E&M services in lieu of the fracture as the fracture is 2 weeks old if manipulation is not required.
CPT vs Medicare Rules
Are we safer to go with the Medicare rules vs CPT rules? Specifically, do you think using Medicare rules would be OK for Workers Compensation and those private payors not using Medicare rues?
The AMA CPT rules are the official source for reporting services to a payor. Medicare writes payment rules for Medicare and instructs carriers to refer physicians to the AMA for questions related to CPT coding. Medicare payment rules constantly change; edits are created and reversed quarterly. Attempting to maintain compliance and consistency when a payor frequently changes rules would be challenging. CPT codes and Guideline are published and updated annually. Medicare payment rules do not include all possible examples of correct coding, as a result, there are instances where a physician could code incorrectly if only the Medicare payment rules were applied.
The following questions were submitted following the 2012 Coding Webinar. This article was reviewed and approved by Daniel J. Nagle MD, Chair, ASSH Coding and Physician Reimbursement Committee.