CPT code 71120 is for an X-ray exam of the breastbone with two or more views, used by healthcare providers to document and categorize this procedure.
CPT code 71120 is used to describe an X-ray examination of the breastbone, also known as the sternum, involving two or more views. This procedure is typically performed to assess any abnormalities, fractures, or conditions affecting the sternum. The multiple views allow for a comprehensive evaluation, providing detailed images from different angles to aid in accurate diagnosis and treatment planning.
When considering whether the CPT codes 71111 and 71120 require any modifiers, it's important to evaluate the specific circumstances under which the services are provided. Modifiers are used to provide additional information about the performed procedure and can affect 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 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. It applies when the facility provides the equipment and technical support for the X-ray, but not the interpretation.
3. Modifier 59 - Distinct Procedural Service: This modifier may be used if the X-ray is performed in conjunction with another procedure, and it is necessary to indicate that the X-ray is a distinct service from other procedures performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician: If the X-ray needs to be repeated on the same day by the same physician, this modifier would be used to indicate that the repeat procedure was necessary.
5. Modifier 77 - Repeat Procedure by Another Physician: Similar to Modifier 76, but used when the repeat procedure is performed by a different physician.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: While typically used for laboratory tests, if the X-ray is repeated for clinical reasons, this modifier might be applicable to indicate the necessity of the repeat test.
7. Modifier 52 - Reduced Services: If the X-ray service was partially reduced or eliminated at the discretion of the physician, this modifier would be used to indicate that the full service was not provided.
8. Modifier 53 - Discontinued Procedure: If the X-ray procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient, this modifier would be applicable.
9. Modifier 99 - Multiple Modifiers: If more than one modifier is necessary to describe the service accurately, Modifier 99 is used to indicate that multiple modifiers apply.
Each of these modifiers serves a specific purpose and should be applied based on the context of the service provided. Proper use of modifiers ensures accurate billing and reimbursement for healthcare providers.
Determining whether CPT code 71120 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) for your specific region.
The MPFS provides a comprehensive list of services covered by Medicare, along with the associated reimbursement rates. Each MAC, which is responsible for processing Medicare claims in different jurisdictions, may have specific coverage policies and guidelines that can affect reimbursement.
To ascertain if CPT code 71120 is reimbursed, healthcare providers should first verify its inclusion in the MPFS. If listed, the next step is to check with the local MAC for any additional coverage criteria or documentation requirements that may apply. This ensures compliance with regional policies and maximizes the likelihood of successful reimbursement.
It is important to stay updated with any changes in the MPFS and MAC guidelines, as these can impact the reimbursement status of CPT code 71120.
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 CPT code 71120, and by individual payer. Schedule a demo today to see how RevFind can help ensure you're receiving the full reimbursement you deserve.
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