Health Information Management

Bill comprehensive and component x-rays using modifier -59

APCs Insider, January 12, 2007

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Bill comprehensive and component x-rays using modifier -59

QUESTION: When a patient arrives to the ED with a cervical collar, or emergency medical services have strapped the patient to a back-board, emergency physicians will order a lateral spine x-ray prior to removing the collar or back-board. This prevents exacerbation of trauma or spinal cord injury. After the lateral x-ray is cleared for acute fracture or injury, the physician completes the exam, and may then order complete spine films (including anteroposterior and lateral).

Does the initial lateral film constitute a separate and distinct service? If so, would this justify appending modifier -59 and allow us to bill both the comprehensive and component radiology exams?

ANSWER: In short, yes. The physician specifically ordered the lateral x-ray to diagnose the patient for the purpose of treatment, which in this case is optimal removal of the back-board or collar.

After that step, as well as a more extensive examination, the physician ordered a separate type of x-ray for more definitive diagnoses. The x-rays are separated by purpose and by timing. For these reasons, you can report the second exam using modifier -59.

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