CPT code 73564 is for a knee X-ray exam involving four or more views, used by healthcare providers to document and categorize this specific procedure.
CPT code 73564 is used to describe an X-ray examination of the knee that involves taking four or more views. This code is typically utilized when a comprehensive assessment of the knee joint is necessary, often to evaluate complex conditions or injuries. The multiple views allow healthcare providers to thoroughly examine the knee's structure, including bones, joints, and surrounding tissues, to ensure accurate diagnosis and treatment planning.
When dealing with CPT codes for X-ray exams of the knee, such as 73562 and 73564, it's important to consider the potential need for modifiers to ensure accurate billing and reimbursement. Here is a list of 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. It indicates that the physician's interpretation of the X-ray is being charged separately from the technical component.
2. Modifier TC (Technical Component): This modifier is used when only the technical component of the service is being billed. It indicates that the charge is for the use of the equipment and the technician's services, excluding the physician's interpretation.
3. Modifier 59 (Distinct Procedural Service): This modifier may be necessary if the X-ray exam 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): This modifier is used if the X-ray exam needs to be repeated on the same day by the same physician due to medical necessity.
5. Modifier 77 (Repeat Procedure by Another Physician): This modifier is applicable if the X-ray exam is repeated on the same day by a different physician.
6. Modifier 52 (Reduced Services): This modifier is used when the service provided is less than what is usually required. It indicates that the procedure was partially reduced or eliminated at the physician's discretion.
7. Modifier 53 (Discontinued Procedure): This modifier is used if the procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
8. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): Although primarily used for lab tests, this modifier can be relevant if the X-ray is repeated for clinical reasons, not due to equipment failure or quality issues.
These modifiers help clarify the nature of the service provided and ensure that the billing accurately reflects the work performed. Proper use of modifiers can prevent claim denials and ensure appropriate reimbursement.
CPT code 73564 is indeed reimbursed by Medicare, as it is included in the Medicare Physician Fee Schedule (MPFS). The MPFS outlines the payment rates for services and procedures covered by Medicare, and CPT code 73564 is listed among those eligible for reimbursement.
However, it's important to note that the reimbursement amount can vary based on geographic location and other factors, as determined by the Medicare Administrative Contractor (MAC) responsible for processing claims in a specific region.
Healthcare providers should consult their local MAC for precise reimbursement details and ensure compliance with any specific billing requirements or documentation needed for CPT code 73564.
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 73564, RevFind provides unparalleled accuracy in identifying discrepancies with individual payers. Schedule a demo today to see how RevFind can enhance your revenue cycle management and secure your financial health.
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
