Did you know that the U.S. medical X-ray market alone is estimated to reach USD 6.09 billion by 2032? This number is enough for radiology centers, hospitals, and radiologists themselves to gear up! How? By streamlining the X-ray billing workflow.
So, if you perform shoulder X-rays often but stumble when it comes to billing, continue reading, as this guide will help you achieve this by discussing everything you need to know about billing CPT code 73030.
CPT Code 73030 – Description
CPT code 73030 covers at least two X-ray views of the patient’s complete shoulder.
Appropriate Use Cases for CPT Code 73030
If you want to understand the proper application of CPT 73030, below are some real-world clinical scenarios:
Acute Traumatic Injury
Picture a 37-year-old female patient who falls directly onto her right shoulder while skiing. She is rushed to the emergency department by her friends. She complains about experiencing severe pain and the inability to raise her hand.
The attending physician suspects a possible proximal humerus fracture or a glenohumeral dislocation. Thus, he orders an X-ray examination of the complete shoulder (CPT code 73030).
The radiology technician captures a minimum of two views, including an anteroposterior (AP) view of the shoulder and a scapular Y view to confirm. The aim was to confirm the position of the humeral head relative to the glenoid fossa and rule out complex fractures.
Chronic Shoulder Pain and Range of Motion Loss
Assume a 70-year-old male patient who comes to his primary care physician for a routine check-up. He complains about experiencing progressive chronic pain and stiffness in his left shoulder over the past month.
The healthcare practitioner suspects rotator cuff arthropathy or osteoarthritis, which is a degenerative joint disease. Thus, he orders a complete shoulder X-ray with an AP view and an axillary lateral view. These views will help the physician assess subacromial spurring, joint space narrowing, and the general condition of the glenoid and humeral head.
Here, CPT code 73030 applies.
Post-Reduction Check (Dislocation)
Imagine a 30-year-old who encountered an anterior shoulder dislocation while playing volleyball. She visited the nearest urgent care center, and the physician successfully performed a closed reduction. Simply put, he put the bone back in place without surgery.
The physician then ordered a new X-ray examination that included a scapular Y view and a standard AP view (CPT code 73030). The X-ray images will help the physician confirm that the humeral head is fully seated within the glenoid fossa.
Modifiers to Append with CPT Code 73030
The following are some of the applicable modifiers related to CPT 73030 to help you ensure coding specificity:
Modifier 26
Did you only interpret the X-ray scans of the shoulder, but don’t own the equipment or resources used to perform the imaging study? If this is the case, report CPT code 73030 with modifier 26.
Modifier LT
How can you specify that you performed the X-ray examination on the left shoulder of the patient? You can easily do it by using modifier LT with CPT code 73030.
Modifier RT
What happens when you perform the X-ray examination on the right shoulder of the patient? You bill CPT code 73030 with modifier RT.
Modifier TC
Radiology centers and hospitals typically append the modifier TC while billing for the complete shoulder X-ray examination. It highlights that you are only billing for the technical component of CPT code 73030.
Reimbursement Guidelines for CPT Code 73030
Discussed below are the essential billing requirements for CPT 73030:
Fulfill Documentation Requirements
The following are the key documentation requirements that must be fulfilled to ensure timely reimbursement against CPT code 73030:
For Medical Necessity Justification
Whether you are billing the global code 73030 as it is, or any single component, your document must demonstrate the medical necessity.
- The patient’s medical record must include a signed physician order requesting the X-ray of the shoulder, along with the reason, e.g., suspected fracture.
- You must precisely link the imaging diagnostic study with the relevant ICD-10-CM codes describing the patient’s symptoms, injury, or suspected condition.
For Technical Component
The radiology technician’s report must confirm the performance of at least two X-ray view examinations of the shoulder. Thus, the report must include:
- The number of X-ray views taken. (Should be at least two or more).
- The specific captured projections, e.g., AP view, axillary view, etc.
- Details of which shoulder the radiology technician imaged with the appropriate laterality modifier, RT or LT.
For Professional Component
If you are billing for the professional component of CPT code 73030, then you must ensure the following:
- A written report detailing the findings and diagnostic conclusions.
- An explanation of what was observed on the radiographs, regardless of their nature, i.e., negative or positive.
Example 1: Anterior glenohumeral joint dislocation is confirmed.
Example 2: Joint spaces are well-maintained without significant erosion, narrowing, or subchondral sclerosis.
- The service date and signature of the licensed physician who interpreted the radiographs.
Do NOT Bill CPT Code 73030 for A Single View X-Ray
The CPT 73030 descriptor clearly states that the reimbursement covers at least two X-ray views. Therefore, you should not report it if the radiology technician only performed a single-view X-ray.
Do NOT Report CPT 73030 with 73020
For context, CPT 73020 covers a single-view X-ray of the shoulder. A common coding error is to bill CPT code 73030 as an add-on code with 73020.
But in reality, they are both individual codes. That is, if you perform at least two X-ray views, you should bill 1 unit of 73030 without 73020.
Final Thoughts on CPT Code 73030
Hopefully, the reimbursement guidelines we discussed in this comprehensive guide will help you ensure a clean claim rate when it comes to billing for CPT code 93030. Just remember to focus on detailed documentation and establishing medical necessity.
Additionally, do not forget to append the relevant modifier if you want to bill only one component of this global service code. That is, modifier 26 for the professional component and modifier TC for the technical component. Besides, appending an appropriate laterality modifier (LT, RT) is equally important.
If, despite understanding how billing is done, you want to outsource radiology billing services to unburden your staff from administrative duties, feel free to partner with NeuraBill.
