April 30, 2014

ACR Radiology Coding Source™ March-April 2014 Q and A

Q: We have a new system that delivers dual-energy bone density measurements in a single-sweep. One of the system’s clinical applications is for Atypical Femur Fracture (AFF) assessment. It provides images of the entire femur for assessment of potential atypical femur fractures to monitor the effects of bisphosphonate therapy over time. The FDA says that any patient on bisphosphonates who presents with thigh or groin pain must be evaluated to rule out femoral fracture. In this case, the one-view evaluation is for patients that present with thigh or groin pain. How should this study be reported?

A: It is appropriate to report CPT code 73550 (Radiologic examination, femur, 2 views) as the service provided is a diagnostic evaluation of the femur. Modifier 52 should be used in conjunction with 73550 to indicate that the procedure performed was altered, i.e., only a one-view evaluation of the femur was provided vs two views. As noted in the CPT 2014 codebook, Under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. Under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. This provides a means of reporting reduced services without disturbing the identification of the basic service."