Health Information Management

Q&A: Can a post-reduction film be charged after a fracture or dislocation?

APCs Insider, October 11, 2013

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

Q: Can a post-reduction film be charged by the hospital radiology department after a reduction of a fracture or dislocation? Can we add modifier -59 (distinct procedural service)? 

A: A post-reduction film is frequently performed to verify proper alignment of the bone. This may be charged by radiology only if there is an order documented by the physician who performed the surgery and separate radiology report is generated. If, however, the C-arm/fluoroscopy is used during surgery, a radiological imaging and interpretation CPT® code should not be reported. This is not the same as a standard post-reduction x-ray. The NCCI manual narrative (chapter 9) indicates that post-reduction films may be reported by hospitals. The manual states:

When limited comparative radiographic studies are performed (e.g., post-reduction, post-intubation, post-catheter placement, etc.), the CPT code for the radiographic series should be reported with modifier -52 [reduced services] indicating that a reduced level of interpretive service was provided. This requirement does not apply to OPPS services reported by hospitals.

You may need to append modifier -59 if the post-reduction film hits an edit with another code on the claim. Before appending the modifier, may sure you have the necessary documentation and supporting requirements (e.g., specific order).

Editor’s note: Denise Williams, RN, CPC-H, vice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Fla., answered this question.

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

Most Popular