Q&A: CPT reporting of diagnostic x-ray services

Q: A child presents to the ED with a closed fracture of his left hand. The physician performs a two-view hand x-ray that shows a small fracture. The physician reduces the fracture and performs a one-view x-ray to ensure alignment. Which CPT® codes and modifiers would be used to report the physician’s services?

 A: The coder would report the two-view hand x-ray using CPT code 73120 (radiologic examination, hand; two views) with laterality modifier -LT (left side). The closed fracture repair is reported using CPT code 26600 (closed treatment of metacarpal fracture, single, without manipulation, each bone) with modifier -LT.

There is no CPT code that specifically describes a one-view hand x-ray. Therefore, the coder would report this service using a second unit of CPT code 73120 with modifiers -LT and -52 (reduced services), and modifier -XU (unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service) or -59 (distinct procedural service). Modifier -52 would be appended to the CPT code to indicate a reduced service was performed. Modifier -XU or -59 would be used to specify that the subsequent x-ray service was a non-overlapping or distinct procedural service.

Editor’s note: Susan E. Garrison, CHCA, CHCAS, CCS-P, CHC, CPAR, CPC, COC, and Sarah L. Goodman MBA, CHCAF, COC, CCP, FCS, answered this question during the HCPro webinar, “2020 Modifier Update: Guidance for Effective Hospital Reporting.”