CPT code 71130 is for an X-ray of the sternoclavicular joint with three or more views, used to diagnose issues in the joint connecting the sternum and clavicle.
CPT code 71130 is used to describe an X-ray procedure of the sternoclavicular joint, which is the joint connecting the sternum (breastbone) and the clavicle (collarbone). This code specifically indicates that the X-ray involves three or more views, meaning multiple images are taken from different angles to provide a comprehensive examination of the joint. This type of imaging is typically ordered to assess for injuries, arthritis, or other abnormalities in the sternoclavicular joint.
When considering whether CPT codes 71120 and 71130 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, such as the location, complexity, or any special circumstances that might affect billing. Below is a list of potential modifiers that could be applicable to these codes:
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, Modifier 26 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 facility provides the equipment and technical staff but not the interpretation.
3. Modifier 59 (Distinct Procedural Service): This modifier may be necessary if the X-ray is performed in conjunction with another procedure that is not typically reported together. It indicates that the procedures are distinct and separate.
4. Modifier 76 (Repeat Procedure by Same Physician): If the X-ray needs to be repeated on the same day by the same physician, Modifier 76 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): Although typically used for lab tests, if the X-ray is repeated for clinical reasons, this modifier might be applicable in certain scenarios.
7. Modifier LT (Left Side) and RT (Right Side): These modifiers are used to specify the side of the body on which the procedure was performed, if applicable.
8. Modifier 52 (Reduced Services): If the procedure is partially reduced or eliminated at the physician's discretion, Modifier 52 can be used to indicate that the service provided was less than usually required.
9. Modifier 53 (Discontinued Procedure): If the procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient, Modifier 53 is applicable.
10. Modifier 99 (Multiple Modifiers): If more than one modifier is necessary to describe the service, 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 the services rendered.
The CPT code 71130 is indeed reimbursed by Medicare, as it is included in the Medicare Physician Fee Schedule (MPFS). The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered.
However, it's important to note that reimbursement rates and coverage can vary based on geographic location and specific Medicare Administrative Contractor (MAC) policies. Each MAC is responsible for processing Medicare claims and may have unique guidelines or requirements for reimbursement.
Therefore, healthcare providers should verify the specific reimbursement details for CPT code 71130 with their respective MAC to ensure compliance and accurate billing.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 71130, RevFind provides unparalleled insights by individual payer. Schedule a demo today to see how RevFind can enhance your revenue cycle management and maximize your financial outcomes.
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
