Medicare Compliance & Reimbursement - 2014 Issue 24
Reader Question: Comparison X-Rays May Not Be Payable
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Article Overview
This article addresses a reimbursement question involving comparison x-rays of an unaffected limb and explains how payers may view these services in different patient scenarios. It is aimed at coding and billing staff, radiology practices, and physicians who need to understand when comparison imaging may be questioned and how documentation and diagnosis reporting are handled across code-set changes. The discussion is framed as a practical coding guidance article focused on medical necessity, payer denial issues, and the transition from ICD-9 to ICD-10 diagnosis reporting.
Why This Topic Matters
Comparison imaging can trigger payer denials if the service is viewed as screening rather than medically necessary. Understanding the documentation and diagnosis-reporting context helps practices manage claims and evaluate whether an appeal is appropriate.
What You Will Learn
- How payer concerns can arise for comparison x-rays of an unaffected limb
- Why documentation of medical necessity matters for comparison imaging
- How diagnosis reporting changes with the transition from ICD-9 to ICD-10
- What types of payer questions may come up in an imaging claim review
Who Should Read This
- Radiology coders
- Billing staff
- Physicians ordering imaging
- Revenue cycle teams
- Practice managers
Codes Discussed
Modifiers Discussed
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