Saturday, September 3, 2016

PROCEDURE CODE 73562, 73560 - Radiology Exam - Knee

PROCEDURE CODE 73560 X-RAY EXAM OF KNEE, 1 OR 2 - Average Fee amount -$25 - $40

PROCEDURE CODE 73562 - Radiologic examination, knee; 3 views

PROCEDURE CODE   Modifier   Description    2015  Payment Rate   2016 Payment Rate   Percent Change in Payment Rate 

73562 X-ray exam of knee 3 $34.50 $35.83 3.9%

73562 26 X-ray exam of knee 3 $10.06 $9.67 -3.9%

73562 TC X-ray exam of knee 3 $24.43 $26.15 7.0%

NCCI Edit for Procedure code 73562

The below codes wont be paid separately when billing together with Procedure code 73562, Use correct Modifier.

01380 36591 36592 73560

Count the Number of Views

The first step when reporting knee X-rays is to check for the number of views your radiologist obtained. More than one view is usually recommended for all knee radiographs. “Your physician may like to see radiographs of the knee joint taken in two planes, 90 degrees opposed to one another, and quite frequently, three views are obtained, and occasionally even more,” says Dr. Bill Mallon, MD, medical director, Triangle Orthopedic Associates, Durham, N.C.

Depending upon the number of views, you report code 73560 (Radiologic examination, knee; 1 or 2 views), 73562 (Radiologic examination, knee; 3 views), 73564 (Radiologic examination, knee; complete, 4 or more views), or 73565 (Radiologic examination, knee; both knees, standing, anteroposterior). “Codes 73760, 73562, and 73654 are simple codes and you just add up the views of the knee to pick up the most appropriate code,”

 Watch When You Report AP View You report code 73565 when the AP view is performed alone. “Procedure code® 73565 should not be used for studies involving two or three views of each knee even if one of the views happens to be standing,” says Hembree. “You report code 73565 when it is the only exam done,” adds Jandroep. You should not forget to document the medical rationale for the AP view. However, if your radiologist obtains the AP view along with the other views of one side, right or left, you report the AP view as an additional view. “Code 73656 can be most challenging,” says Jandroep.

Example: You may read that your radiologist obtained a standing AP view X-ray of the knee in addition to the oblique and lateral views, you do not report code 73565. You instead count the standing AP view as a third view and you report code 73562. “When standing views are taken in addition to other views, then you should add the total number of views taken together and report based off the total views of each knee,” says Hembree.

For Procedure CODE 73562 We could do the Submission of Modifier 26 (Professional Component) and Modifier TC (Technical Component) Certain procedures are a combination of a physician component (Modifier 26) and a technical component (Modifier TC). When the physician component or technical component is done by separate physicians, modifier 26 or Modifier TC should be added to the submitted Procedure code /HCPC code. A code is reimbursable with a Modifier 26 or Modifier TC components. Codes submitted with Modifier 26 or Modifier TC when there are no separate RVUs assigned will be denied as part of the global reimbursement. Current codes that are eligible for separate reimbursement when submitted with Modifier 26 and Modifier TC .

Rationale for Edit: 

Anthem Central Region does not bundle 73060, 73100, 73110, 73120, 73562, 73600 or 73610 with 76006. Based on Procedure code Assistant,

"76006 Radiologic examination, stress view(s), any joint stress applied by a physician {includes comparison views} Code 76006 was added as a stand alone code to address the procedure in which a physician performs stress to a joint during radiographic filming of that joint. The appropriate joint radiologic code should be additionally reported."

Based on the National Correct Coding Guide, codes 73060, 73100, 73110, 73120, 73562, 73600 or 73610 are not listed as component codes to code 76006. Therefore, if any of these codes 76060, 73100, 73110, 73120, 73652, 73600 or 73610 is submitted with 76006-both reimburse separately

For Procedure codes 73060 and 73560, Addendum B lists two separate global periods for these codes depending on the modifier.

Code 73565 is used for a standing view of both knees when morphology (form and structure) is examined. This examination is performed typically on patients with osteoarthritis and for presurgical planning. This code should be reported when the anteroposterior (AP) standing view is the only view taken. This code should not be used for studies involving two or three views of each knee even if one of the views happens to be upright (see codes 73560, Radiological examination, knee; one or two views; 73562, Radiological examination, knee; three views; and 73564, Radiological examination, knee; complete four or more views, to report radiological examination of the knee)

Clarification of Modifier 76 for Radiology/Imaging 

Modifier 76 is used to designate a repeat study on the same date of service for the same patient by the same physician or healthcare provider. Modifier 76 does not provide for reimbursement of an ineligible service and no additional reimbursement will be issued for services if the reimbursement to the physician is via capitation.

Horizon BCBSNJ will reimburse repeat procedures or services performed by the same physician for the same patient on the same date of service appropriately appended with Modifier 76 at the applicable fee schedule amount when the procedure(s) meet the guidelines cited below. Any procedure that does not meet the guidelines below will not be reimbursable.

To help ensure the accurate adjudication of claims, we ask that you adhere to the following Modifier 76 guidelines:

73560 Radiologic examination, knee; 1 or 2 views 1 2

73562 Radiologic examination, knee; 3 views

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