Sometimes, a simple medical procedure, such as an X-ray, becomes too complicated to bill, and medical practices end up with financial losses. The reason behind this is that healthcare providers are unaware of the appropriate CPT codes or a particular payer’s guidelines for a medical procedure.
In today’s blog, we will discuss one of the common radiology CPT codes used to report a complete foot X-ray. You will learn to bill CPT code 73630, including the situations in which this code is applicable, its modifiers, and the specific billing guidelines.
Read this comprehensive guide before billing for foot X-ray services.
CPT Code 73630 – Description
CPT code 73630 refers to a diagnostic radiologic examination of the foot (including toes and calcaneus) with a minimum of three views: dorsoplantar (AP view), lateral, and oblique.
This comprehensive X-ray imaging enables healthcare providers to analyze bones and soft tissues within the foot from multiple angles. It is usually required to diagnose fractures, dislocations, infections, arthritis, tumors, or other abnormalities within the foot.
Appropriate Use Cases for CPT Code 73630
Let us explain the correct uses of CPT code 73630 in the light of some practical medical scenarios.
Persistent Foot Pain
Let’s take an example of a 45-year-old patient who visits a healthcare clinic with foot pain for several months. He has tried multiple over-the-counter painkillers and resting, but it has kept getting worse. The physician observes soreness around the mid-foot bones, so he orders a full-foot weight-bearing X-ray with multiple views to look for possible reasons such as stress fractures, joint abnormalities, or bone deformities. The radiologic examination of the foot is reported with the CPT code 73630.
Foot Injury
For our second example, suppose a 27-year-old man is brought to the emergency department because he twisted his foot during a weekly soccer match. The physician sees clear swelling on his left foot, and the patient is unable to stand properly.
The physician immediately orders a full radiographic examination of the foot to assess the alignment of the bones and joints because he believes there may be a fracture or dislocation.
Hence, this X-ray imaging of the foot from three sides is billed with CPT code 73630.
Modifiers to Append with CPT Code 73630
The following are some commonly used modifiers with the 73630 CPT code.
Modifier 26
Did you only perform the professional component of the radiology test, which means interpreting the X-ray results and reporting the findings? Then, modifier 26 (indicating the professional component) shall be applied to CPT code 73630.
Modifier TC
In contrast, modifier TC refers to the technical component and must be applied to CPT code 73630 for the billing of technical aspects, such as equipment use, supplies, and the technician’s time. Note that a radiology facility is allowed to append the modifier TC, and not the ordering physician or radiologist.
Modifier LT
If the X-ray was performed on the left foot, you must bill CPT code 73630 with the modifier LT.
Modifier RT
However, if the X-ray was performed on the right foot, you must bill code 73630 with the modifier RT.
Modifier 50
Modifier 50 is used to indicate a bilateral procedure. It means the X-ray was performed on both left and right feet during the same session.
Reimbursement Guidelines for CPT Code 73630
You can follow these reimbursement guidelines for CPT code 73630 to avoid receiving denials.
Provide Complete Documents
Before submitting your claims to the payers, ensure that your paperwork is complete and accurate. Specifically, you must mention in your documents that a minimum of three views were performed for CPT code 73630. Furthermore, the following information must be included in your documents.
- The medical necessity for the X-ray with the appropriate ICD-10 code(s).
- The patient’s condition and symptoms, e.g., injury, pain, trauma, swelling, etc.
- Number of views
- Laterality (right, left, or bilateral)
- Radiologist’s interpretation and report
- Date and location of imaging
Understand Bundling Rules
According to the Medicare Policy Manual Chapter 9, you cannot bill CPT code 73650 (X-ray of calcaneus, 2 views) or 73660 (X-ray of toes, 2 views) with the CPT code 73630 for the same foot. The policy states that this code includes an X-ray of the calcaneus heel and toes. Hence, a physician should not report either radiological examination of the calcaneus or toe with a three-view X-ray for the same foot on the same date of service, as it would indicate a repetition of radiology services.
Follow Payer’s Specific Policies
Every payer has its own way of reimbursing claims. They may differ from each other in policies, reimbursement rates, accepted modifiers, and documentation requirements. Furthermore, your reimbursement depends on whether the X-ray was performed in a facility or non-facility setting, the Medicare Administrative Contractor (MAC) locality, and whether the professional or technical component is billed.
To ensure that your claim submission is compliant, you must review the policies, billing requirements, and reimbursement rates of payers.
Final Thoughts
In summary, we have covered every aspect of billing CPT code 73630, including its real-world examples, relevant modifiers, and billing guidelines.
However, we highly recommend using NeuraBill’s expert radiology billing services if you are still struggling with coding or keeping denials to a minimum.
