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You can separately bill intraoperative radiographs when fully documented

Question: I’m looking at procedures that a surgeon’s coders want to code, including a ligament reconstruction tendon interposition (LRTI) (25447) and an ORIF of carpal scaphoid (25628). At the end, they also billed 73110-26 (Radiological examination, wrist; complete, minimum of three views).

For the imaging, the report states the following: “Multiple views including antero-posterior (AP), lateral and oblique radiographs of the wrist were performed in order to confirm that a complete trapeziectomy was performed and first metacarpal and second metacarpal spaces were well aligned and that the hardware and reduction of the scaphoid were appropriate and this was confirmed radiographically.”

I’m stuck on the idea that 73110 shouldn’t have been billed. Am I right? Do you have any citation on it somewhere? I’m going to need it.

Answer: The radiological imaging should be billable by the surgeon in this case, at least if the procedure is performed in an ambulatory surgery center (ASC). In the outpatient hospital setting, a radiologist would likely perform and bill for the interpretation.

The American Academy of Orthopaedic Surgeons (AAOS) has stated that imaging should be separately billable if the surgeon documents a detailed radiographic interpretation in the note (as the surgeon does in the question above) and the X-rays are saved in the patient’s medical record and are available to be printed on request.

However, if the surgeon merely documents: “X-rays were taken, looks good,” that would not support a separate charge for intraoperative imaging. The interpretation must include a detailed assessment of the specific musculoskeletal structures addressed during surgery and an assessment of the results.

Make sure to append the 26 modifier (professional component) to signal that the surgeon did the interpretation and not the technical component.