CPT code 70328 is for an X-ray exam of the jaw joint, used by healthcare providers to document and identify this specific diagnostic procedure.
CPT code 70328 is used to describe an X-ray examination of the jaw joint, also known as the temporomandibular joint (TMJ). This procedure involves taking radiographic images to assess the structure and function of the TMJ, which connects the jawbone to the skull. The X-ray helps healthcare providers diagnose issues such as joint disorders, arthritis, or injuries affecting the jaw joint.
When considering whether CPT codes 70320 and 70328 require any modifiers, it's important to understand the context in which these procedures are performed. Modifiers are used to provide additional information about the performed procedure, such as indicating that a service was altered in some way without changing its definition or code. 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 being billed. For example, if a radiologist interprets the x-ray but does not own the equipment, this modifier would be appropriate.
2. Modifier TC - Technical Component: This modifier is used when only the technical component of the service is being billed. This applies when the provider owns the equipment and performs the x-ray, but another provider interprets the results.
3. Modifier 52 - Reduced Services: This modifier may be used if the procedure was partially reduced or eliminated at the discretion of the physician. For instance, if fewer images than typically required for a full mouth x-ray were taken due to patient limitations.
4. 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 applicable if multiple x-ray services are performed on the same day but are unrelated.
5. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used if the same procedure is repeated by the same provider on the same day. It could apply if an additional x-ray is needed due to initial image quality issues.
6. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used if the same procedure is repeated by a different provider on the same day. This might occur if a second opinion is needed for the x-ray interpretation.
7. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although primarily used for lab tests, this modifier can sometimes be relevant if the x-ray is repeated for clinical reasons, not due to equipment failure or quality issues.
These modifiers help ensure accurate billing and reimbursement by providing additional context for the services rendered. It's crucial for healthcare providers to use the appropriate modifiers to avoid claim denials and ensure compliance with payer requirements.
Determining whether CPT code 70328 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and guidance from your regional Medicare Administrative Contractor (MAC). The MPFS provides a comprehensive list of services covered by Medicare, along with their respective reimbursement rates. However, coverage can vary based on geographic location and specific MAC policies.
To ascertain if CPT code 70328 is reimbursed, healthcare providers should first check the MPFS for the current year to see if the code is listed and to review any associated reimbursement rates. Additionally, it's crucial to consult with your local MAC, as they have the authority to interpret Medicare policies and may have specific guidelines or requirements for reimbursement in your area. This dual approach ensures that providers have the most accurate and up-to-date information regarding Medicare reimbursement for CPT code 70328.
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 70328. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and 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
