CPT code 73551 is used for an X-ray exam of the femur, capturing one view to help diagnose fractures or other conditions affecting the thigh bone.
CPT code 73551 is used to describe an X-ray examination of the femur, which is the thigh bone. This code specifically indicates that the X-ray is taken from one or two views, meaning that the images are captured from different angles to provide a comprehensive look at the femur. This type of imaging is typically ordered to assess for fractures, abnormalities, or other conditions affecting the femur.
When considering the use of modifiers for the CPT codes 73550 and 73551, it's important to understand the context of the service provided and the specific circumstances that might necessitate a modifier. 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 is interpreting the X-ray but not providing the technical component (e.g., the actual taking of the X-ray), this modifier would be appropriate.
2. Modifier TC - Technical Component: This is used when only the technical component of the service is being billed. This would apply if the facility is billing for the use of the equipment and the technician's time, but not the radiologist's interpretation.
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 used if multiple X-rays are taken of different anatomical sites or if the X-ray is part of a separate encounter.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is applicable if the same physician performs a repeat X-ray on the same day. It indicates that the procedure was necessary and not a duplicate billing error.
5. Modifier 77 - Repeat Procedure by Another Physician: Similar to Modifier 76, this is used when a repeat X-ray is performed on the same day by a different physician.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although typically used for lab tests, if an X-ray is repeated for clinical reasons, this modifier might be applicable to indicate the necessity of the repeat test.
7. Modifier LT - Left Side: This modifier is used to specify that the X-ray was performed on the left side of the body.
8. Modifier RT - Right Side: This modifier is used to specify that the X-ray was performed on the right side of the body.
9. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion. It might apply if the full X-ray series was not completed.
10. Modifier 53 - Discontinued Procedure: This is used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
Each of these modifiers serves a specific purpose and should be used in accordance with the specific circumstances surrounding the X-ray service provided. Proper use of modifiers ensures accurate billing and reimbursement.
The CPT code 73551 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 that could affect reimbursement for CPT code 73551.
Therefore, healthcare providers should verify the specific reimbursement details with their respective MAC to ensure compliance and accurate billing.
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 73551, 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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