“Which ICD 10 code should one use for postoperative x-rays after a bunionectomy, a hammertoe repair, or amputation? United Health Care denied payment for post op x-rays. This hasn’t happened before. Thank you.”
What a surprise! UHC strikes again! Reimbursement for postoperative X-rays has not been an issue. We have not had a problem billing for postoperative X-rays using the original ICD-10-CM code that was used for the pre-operative X-rays and for the reason(s) that the surgical procedures were performed (ie. Hallux valgus, Hammertoe, why the amputation needed to be performed (ie. osteomyelitis). Apparently, this is no longer sufficient per United Health Care.
I have a couple of suggestions:
1a. I would still use the ICD-10-CM code that was the reason for performing the surgical procedure as the primary diagnosis code for the postoperative X-rays:
-M20.11 (Hallux valgus (acquired), right foot; M20.12 (Hallux valgus (acquired), left foot)
-M20.42 (Other hammertoe(s) (acquired), right foot; M20.42 (Other hammertoe(s) (acquired), left foot
-M86.171 (Other acute osteomyelitis, right ankle and foot); M86.172 (Other acute osteomyelitis, left ankle or foot) or, of course, the most appropriate ICD-10-CM code for why the amputation was performed and why the postoperative X-rays are required
1b. I would use the following secondary ICD-10-CM codes:
-Z47.89 (Encounter for other orthopedic aftercare). This would be appropriate for the postoperative X-rays for the hallux valgus correction and for the hammertoe correction.
-Z47.81 (Encounter for orthopedic aftercare following surgical amputation). This is self -explanatory.
2. If #1 above fails, I would try the following: I would append the 76 modifier to the CPT code that is billed for the post-operative X-rays (ie. CPT 73630 – RT/LT). The 76 modifier is defined as the following: REPEATED PROCEDURE BY THE SAME PHYSICIAN – It may be necessary to indicate that a procedure or service was repeated subsequent to the original procedure or service. This circumstance may be reported by adding modifier 76 to the repeated procedure or service.
This is my opinion.
Michael G. Warshaw, DPM, CPC
Terrific NEWS!!!
THE 2025 PODIATRY CODING MANUAL IS NOW AVAILABLE in either Book or Flash-drive formats. It has been completely updated for the calendar year 2025 including the NEW policy for the application of skin substitutes that goes into effect February 12, 2025. Many offices across the country consider this to be their “Bible” when it comes to coding, billing, and documentation. The price is still only $125 including shipping! To purchase, access the website drmikethecoder.com.
No credit card? No problem! Just send a check for $125 to the following address:
Dr. Michael G. Warshaw
2027 Bayside Avenue
Mount Dora, Florida 32757
Read Comments