CPT code 73090 is used to identify and describe an X-ray exam of the forearm, aiding in the standardized documentation of healthcare services.
CPT code 73090 is used to describe an X-ray examination of the forearm. This code is specifically utilized when a healthcare provider orders an imaging study to evaluate the bones and surrounding structures of the forearm, which includes the radius and ulna. The X-ray can help diagnose fractures, infections, or other abnormalities in the forearm area. This code ensures that the procedure is accurately documented for billing and insurance purposes within the healthcare revenue cycle.
When considering whether CPT codes 73085 and 73090 require any modifiers, it's important to understand the context in which these codes are used and the specific circumstances of the procedure. Here is a list of potential modifiers that could be applied to these codes:
1. Modifier 26 (Professional Component): This modifier is used when only the professional component of the service is being billed. For instance, if a radiologist is interpreting the x-ray but not providing the technical component (e.g., the equipment and technician), 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 would apply if the facility is providing the equipment and technician but not the interpretation of the x-ray.
3. 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 and need to be reported separately.
4. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used when the same procedure is repeated by the same physician on the same day. It could be applicable if the x-ray needs to be repeated due to technical issues or to monitor changes.
5. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when the same procedure is repeated by a different physician on the same day. It might be necessary if a second opinion or additional expertise is required.
6. Modifier 52 (Reduced Services): This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion. It could apply if the full scope of the x-ray examination was not completed.
7. Modifier 53 (Discontinued Procedure): This modifier is used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient. It might be relevant if the x-ray procedure had to be stopped unexpectedly.
8. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): While typically used for lab tests, this modifier can sometimes be relevant in imaging if the test is repeated for clinical reasons on the same day.
The use of these modifiers depends on the specific circumstances of the service provided, and healthcare providers should ensure accurate documentation to support the use of any modifiers.
The CPT code 73090 is reimbursed by Medicare, as it is included in the Medicare Physician Fee Schedule (MPFS).
The reimbursement rates and coverage details for this specific CPT code can vary based on geographic location and other factors, which are determined by the respective Medicare Administrative Contractor (MAC) in your area.
Each MAC is responsible for processing claims and setting local coverage determinations, so it is essential to consult with your regional MAC to understand the specific reimbursement rates and any additional requirements for CPT code 73090.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments down to the CPT code level, including specific codes like 73090, 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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