Important Information From a Medicare Standpoint Regarding X-rays

General Guidelines for X-Rays:

1. 1. Medicare does not pay for screening x-rays. Abnormal signs or symptoms or an established disease or injury is needed to provide the Medical Necessity for taking X-rays.
2. 2. CPT Codes 73620 and 73630 are not payable together on the same day on the same extremity.
3. 3. Medicare will pay for yearly X-rays for stable conditions only if it is Medically Necessary.
4. 4. Most Medicare carriers will allow and reimburse for one post-operative X-ray study, unless there is medical necessity for more frequency. Document within the medical record.
5. 5. It is necessary to justify the need for a complete X-ray study versus a limited study.
6. 6. Comparison studies involving an unaffected extremity does NOT demonstrate medical necessity.

Most Common Podiatry Studies:

73600 Radiologic examination, ankle; two views; professional + technical component

73610 Radiologic examination, ankle; complete, minimum of three views; professional + technical component

73620 Radiologic examination, foot; two views; professional + technical component

73630 Radiologic examination; foot; complete, minimum of three views; professional + technical component

73650 Radiologic examination; calcaneus, minimum of two views; professional + technical component

73660 Radiologic examination; toe(s), minimum of two views; professional + technical component

Use the appropriate modifier, as applicable, for the above codes. An anatomical modifier used solely, usually indicates the bill is for both professional and technical components (i.e. -26 professional, -TC technical).

Appropriate Documentation for an X-ray Report:

1. 1. State the actual views that were obtained.
2. 2. Document a general overview of the X-rays that were obtained. Certainly, there are other, identifiable issues present in addition to the diagnosis that you ordered the X-rays for
3. 3. "Target the Diagnosis." Whenever X-rays are obtained, there is a diagnosis code that is used to not only justify obtaining the X-rays, but also to bill for those X-rays. Wouldn't it behoove you to make mention of that diagnosis in the X-ray report?

This is my opinion.

Michael G. Warshaw

DPM, CPC

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