Coding for x-rays of knees and pelvis exploring for arthritis
I am hoping you can provide clarity on what can be reported when a patient presents with an order for:
- X-ray Bilateral Knees, minimum of 4 views
- X-ray Knees Standing AP, and
- X-ray Pelvis, 1 or 2 views
The referring physician’s notes state these x-rays are ordered “to see if there is arthritis or not”. However, the only Reason for Exam documented is “right knee pain, unspecified chronicity”.
May I consider the left knee and the pelvis views medically necessary with “right knee pain” as the indication for these exams?
If you only have a diagnosis that supports medical necessity for the right knee but the doctor is checking for arthritis in other sites, then you would report:
For the right knee, you would report CPT® code 73564-RT with an ICD-10-CM diagnosis code of M25.561, pain in right knee. If the final exam report states arthritis, then you may report the appropriate diagnosis code for arthritis.
For the left knee, you would report CPT code 73564-LT with an ICD-10-CM diagnosis code of Z04.89, encounter for examination and observation for other specified reasons.
If the final exam report states arthritis, then you may report the appropriate diagnosis code for arthritis.
You would do the same for the pelvis. You would report CPT 72170 with an ICD-10-CM diagnosis code of Z04.89 (or the appropriate code for arthritis if found).
It will be up to the individual payor’s medical necessity policy as to whether the x-rays for the left knee and/or pelvis will be covered. Medical necessity policies vary widely.
The codes and full descriptions are as follows:
73564 Radiologic examination, knee; complete, 4 or more views
72170 Radiologic examination, pelvis; 1 or 2 views