by Wyn Staheli, Director of Content - innoviHealth
May 23rd, 2023
It’s probably not surprising that the most commonly billed imaging services are radiologic examinations of the humerus, spine, fingers, and abdomen (codes 72070, 73060, 73140, 74019). However, there are currently 653 CPT codes in the main imaging section (70000-79999). Therefore, it’s worth it to take a few moments to review some important information about these services to ensure that proper coding (including the correct use of modifiers) takes place. This can help your organization ensure correct coding and reimbursement and thus minimize the chances for claim denials and payer take-backs (post-payment denials).
The following are the most commonly used modifiers (in alphabetical order) when billing radiology services:
26: Professional component: The healthcare provider ONLY reviews imaging that has been performed elsewhere and is providing their own interpretation of these previously performed images. Click HERE to review important information from one payer about its use.
50: Bilateral procedure: Both sides (right and left, not front and back) of the body are imaged. Be aware that this modifier cannot be used when the description clearly states that the procedure performed is bilateral.
59: Distinct procedural service: There may be situations where a service should not be considered bundled into another service. However, this modifier is under close payer scrutiny so it should be used with caution and never in place of modifiers 50, RT, or LT.
- Click HERE to review information from one payer about using modifier 59 with radiology services.
- Click HERE for another informative article about when to report modifier 59 with radiology services.
76: Repeat procedure by same physician: The original imaging service is repeated by the same physician on the same day as the original imaging service. Click HERE for an article about using this modifier.
77: Repeat procedure by another physician: the original imaging service is repeated by a different physician on the same day as the original imaging service. Click HERE for an article about using this modifier.
RT: Right side: Procedure is performed on the right side of the body
LT: Left side: Procedure is performed on the left side of the body
TC: Technical component: Includes only the cost of equipment, staff, supplies and machinery required to take the image. No professional interpretation is done.
There are two other modifiers that providers need to be aware of: modifier FX and modifier FY. As imaging has moved from film to digital, the pricing also needed revising. Since there are no specific codes for digital x-ray versus plain x-rays, that differentiation is done with the proper use of these modifiers. Click HERE to read more about these modifiers.
Radiology Issues Webinar
Be sure to tune in for our free webinar “Common Coding Issues in Radiology” which will take place on May 25, 2023. As indicated by the title, this webinar will go over common problems, how to properly count views, modifiers, documentation, and other essential information to ensure that your organization is doing things correctly.
CLICK HERE to register for the webinar.
About Wyn Staheli, Director of Content - innoviHealth
Wyn Staheli is the Director of Content Research for innovHealth. She has over 30 years of experience in the healthcare industry. With her degree in Management Information Systems (MIS), she has been a programmer for a large insurance carrier as well as a California hospital system. She is also the author and editor of many medical resource books and the founder of InstaCode Institute.