As a medical practitioner, you aim to provide healthcare services and generate income from them. However, earning this income can be challenging, as medical billing relies on complex coding systems that are necessary for reimbursement. Insurance payers obligate healthcare professionals to report their services using specific CPT codes.
To make medical billing easier for you, we have come up with a solution. We prepare comprehensive guides on CPT codes so you can have easy access to all the information required for accurate medical coding and billing.
In this read, we have picked a code from radiology billing. CPT code 73030 represents a shoulder X-ray. Now, to find out the billing details about this code, you have to read this blog. So let’s get started.
CPT Code 73030 – Description
CPT code 73030 is used to report an X-ray procedure of the shoulder to get a comprehensive view of the joint and surrounding bones.
This code specifically refers to a complete radiological evaluation, which typically includes multiple views (minimum 2 views) of the shoulder joint.
Physicians usually require this X-ray to assess the bones and surrounding structures for any abnormalities, such as fractures, dislocations, or degenerative changes.
Scenarios Where CPT Code 73030 is Applicable
To further understand where CPT code 73030 is applicable, you can read the following scenarios.
Dislocation of the Shoulder
Suppose a teenager falls directly on his shoulder from a joyride at an amusement park. His parents rush him to an emergency department while he is in severe pain and has swelling. The physician suspects a shoulder fracture or dislocation, so he orders an X-ray before beginning any medical treatment. The radiologist performs a complete shoulder X-ray with multiple views to assess the shoulder joint and check for any bone fragments or fractures. In this scenario, the radiologist can use CPT code 73030 for an X-ray of the shoulder with multiple views.
Post-Operative Analysis
Suppose a 60-year-old man was suffering from chronic shoulder arthritis, so he underwent a shoulder replacement surgery to replace the shoulder joint. The patient comes back for a follow-up visit after the operation. The physician orders a shoulder X-ray to evaluate his recovery, shoulder function, and to detect any potential complications. For monitoring post-operative healing and organizing any necessary follow-up treatments, this imaging is essential. The radiologist carrying out this multiple-view X-ray of the patient can bill this service with CPT code 73030.
Shoulder Bursitis
Imagine a 35-year-old diabetic man comes to a physician’s office. He tells the physician that he is currently suffering from excruciating shoulder pain and stiffness, causing limited shoulder movement. When the healthcare provider physically analyzes his shoulder, he finds redness and swelling around his skin. The patient’s symptoms point towards bursitis. However, to confirm or rule out his suspicion, the physician orders a complete shoulder X-ray with multiple views. So, in this case, the radiologist can apply CPT code 73030 to bill his part of the service.
Applicable Modifiers for CPT Code 73030
The following are some applicable modifiers for CPT code 73030. Healthcare providers may append them depending on the particular situation.
Modifier 26
Modifier 26 is used to signify the professional component of the service. This means that if the physician interprets the shoulder X-ray results and documents them to create a treatment plan, he can append modifier 26 to CPT code 73030.
Modifier TC
This modifier indicates that only the technical aspect of the X-ray service is being billed for reimbursement. It specifies that a radiology facility is submitting the claim and charging for the equipment, supplies, and technician’s services.
Modifier LT
The radiologist can apply this modifier with CPT code 73030 to indicate that the X-ray service was performed on the left shoulder.
Modifier RT
In contrast, the radiologist can apply the RT modifier with CPT code 73030 to indicate that the imaging service was performed on the right shoulder.
Modifier 59
This modifier signifies that the X-ray exam was a separate service from other procedures performed on the same day.
CPT Code 73030 – Billing & Reimbursement Guidelines
The following are the billing guidelines that you must be aware of before filing claims for CPT code 73030.
Submit Detailed Documentation
To receive compensation for your rendered services, you must provide proper documentation. It helps insurance payers understand the medical necessity of the performed procedure and decide the reimbursement rate accordingly. Hence, your documents must be accurate and complete.
The following should be included in your CPT code 73030 documentation:
- Medical necessity of the service
- Related ICD-10 diagnosis codes
- The patient’s age and the date of the X-ray
- The details of the ordering medical professional or other authorized person
- The quantity of views obtained (the code requires a minimum of 2)
- The provider’s interpretation and report of the images
- Results and perceptions pertinent to the patient’s health
Be Mindful of the Minimum Views
As we have mentioned earlier, you cannot bill CPT code 73030 for less than two views. If you have taken at least two X-ray views of the shoulder, then you are eligible to bill this code. Otherwise, you will face a claim denial. There is an alternative code for less than 2 views, CPT code 73020.
Follow Payer-Specific Guidelines
Medicare and various insurance payers will reimburse for CPT code 73030 if the provider can adequately demonstrate the need for the procedure. It is important to review the specific guidelines of each payer to determine if prior authorization is necessary. Generally, prior authorization is not needed in outpatient scenarios. However, it is always advisable to adhere to the specific policies of each payer for the reimbursement of services.
Final Word
Here, we conclude our comprehensive guide to CPT code 73030. But before wrapping up, let’s briefly go through the key takeaways. This code reports a shoulder X-ray with at least 2 views. There are several clinical situations in which this CPT code is applicable, such as to diagnose shoulder fracture or dislocation, shoulder bursitis, or for post-surgery evaluation. Some of the modifiers that are frequently appended to this code include modifiers 26, TC, LT, RT, and 59, depending on the situation.
We also covered the crucial billing and reimbursement rules for CPT code 73030. However, if you are still confused, we recommend hiring expert radiology billing services to file clean and compliant claims.
