CPT code 70110 is for an X-ray exam of the jaw with four or more views, used by healthcare providers to document and categorize this specific diagnostic service.
CPT code 70110 is used to describe an X-ray examination of the jaw that involves four or more views. This means that the radiologist will take at least four different images from various angles to thoroughly assess the jaw area. This type of X-ray is typically ordered to diagnose issues such as fractures, infections, or other abnormalities in the jawbone.
When considering the use of modifiers for the CPT codes related to X-ray exams of the jaw, it's important to understand the context in which these modifiers might be applied. Modifiers are used to provide additional information about the performed procedure, such as changes in service, specific circumstances, or to ensure proper reimbursement. Here is a list of potential modifiers that could be applicable:
1. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is provided. For instance, if a radiologist interprets the X-ray but does not own the equipment, this modifier would be appropriate.
2. Modifier TC - Technical Component: This is used when only the technical component of the service is provided. It applies when the facility owns the equipment and performs the X-ray, but the interpretation is done elsewhere.
3. Modifier 52 - Reduced Services: This modifier may be used if the procedure is partially reduced or eliminated at the physician's discretion. For example, if fewer views are taken than initially planned due to patient condition or other factors.
4. Modifier 76 - Repeat Procedure by Same Physician: If the X-ray needs to be repeated on the same day by the same provider due to technical issues or to obtain better images, this modifier would be applicable.
5. Modifier 77 - Repeat Procedure by Another Physician: This is used when the procedure is repeated on the same day by a different provider, perhaps due to a referral or second opinion requirement.
6. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It might be necessary if multiple imaging services are performed that are not typically reported together.
7. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although primarily used for lab tests, if the X-ray is repeated for clinical reasons and not due to equipment failure or quality issues, this modifier might be considered.
It's crucial to verify payer-specific guidelines as they may have unique requirements or restrictions regarding the use of these modifiers. Proper documentation should always accompany the use of any modifier to ensure clarity and justification for its application.
Determining whether CPT code 70110 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractors (MACs). The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered. Each year, the Centers for Medicare & Medicaid Services (CMS) updates this schedule, which includes the reimbursement rates for various CPT codes.
To ascertain if CPT code 70110 is reimbursed, healthcare providers should first check the MPFS for the current year. This will provide information on whether the code is covered and the associated reimbursement rate. Additionally, MACs, which are regional contractors that process Medicare claims, may have specific guidelines or local coverage determinations (LCDs) that affect the reimbursement of certain CPT codes, including 70110.
It is essential for healthcare providers to verify with their specific MAC to ensure compliance with any regional policies or requirements that might impact the reimbursement of CPT code 70110. By consulting both the MPFS and the relevant MAC, providers can accurately determine the reimbursement status of this code under Medicare.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including specific codes like 70110, and by individual payer. Schedule a demo today to see how RevFind can help ensure you're receiving the full reimbursement you deserve.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
