CPT code 72114 is for an X-ray exam of the lumbar-sacral spine with bending views, used to assess spinal alignment and flexibility.
CPT code 72114 is used to describe an X-ray examination of the lumbar-sacral (l-s) spine with bending views. This diagnostic imaging procedure involves taking X-ray images of the lower back region, specifically focusing on the lumbar and sacral areas of the spine. The "bending" aspect refers to the patient being asked to bend forward, backward, or sideways during the X-ray to assess the flexibility and alignment of the spine. This type of X-ray is often used to evaluate conditions such as scoliosis, spinal instability, or other abnormalities in spinal curvature and movement.
When considering the use of modifiers for the CPT codes 72110 and 72114, it's important to understand the context in which these codes are used and the specific circumstances of the X-ray exams. 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. This applies when the facility owns the equipment and performs the X-ray, but the interpretation is done separately.
3. Modifier 59 - Distinct Procedural Service: This modifier may be used if the X-ray exam is performed in conjunction with another procedure that is not typically performed together, and it is necessary to indicate that the procedures are distinct and separate.
4. Modifier 76 - Repeat Procedure by Same Physician: If the X-ray exam needs to be repeated on the same day by the same physician due to clinical necessity, this modifier would be appropriate.
5. Modifier 77 - Repeat Procedure by Another Physician: If the X-ray exam is repeated on the same day by a different physician, this modifier should be used.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although primarily used for laboratory tests, if the X-ray is repeated for clinical reasons, this modifier might be considered, though it is less common for radiology.
7. Modifier 52 - Reduced Services: If the X-ray exam is partially reduced or not completed as initially intended, this modifier can be used to indicate that the service was less than what is typically required.
8. Modifier 53 - Discontinued Procedure: If the X-ray exam is started but discontinued due to patient safety or other reasons, this modifier would be appropriate.
9. Modifier 99 - Multiple Modifiers: If more than one modifier is necessary to describe the circumstances of the X-ray exam, this modifier indicates that multiple modifiers are being used.
It is crucial to verify the specific payer policies and guidelines, as the necessity and appropriateness of modifiers can vary. Proper documentation should support the use of any modifier to ensure compliance and accurate reimbursement.
The CPT code 72114 is subject to reimbursement by Medicare, but it is essential to verify its status through the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set by 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 and payment can vary based on local policies established by MACs, which are responsible for processing Medicare claims and ensuring compliance with Medicare guidelines.
Therefore, healthcare providers should consult both the MPFS and their MAC to confirm the reimbursement status and any specific requirements or documentation needed for CPT code 72114.
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 72114, RevFind provides unparalleled accuracy and insight. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and optimize your revenue cycle management.
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
