Radiology billing is challenging to master. Many experienced billers make mistakes while filing seemingly simple codes. If you have experience working in a radiology lab, you must be aware of the frequency of knee X-rays. Among the most common knee scanning codes is CPT code 73562.
Do you know that CPT 73562 accounts for approximately 1.3% of all radiology procedures performed at imaging centers? That translates to a lot of revenue for practices. So, if the claims for this code get denied, it will result in a significant revenue loss.
To ensure that your practice remains financially sustainable, we have created this detailed guide on CPT code 73562. Take a look.
CPT Code 73562 – Description
CPT code 73562 is officially defined as:
“Radiologic examination, knee; 3 views.”
That definition is simple and self-explanatory. However, you should know the details.
Code 73562 falls under the ‘Diagnostic Imaging’ category of CPT codes. It represents a simple X-ray procedure that involves capturing three distinct X-ray images of a patient’s knee joint. The scans are usually taken from anteroposterior (front-to-back), lateral (side), and an additional view, such as a sunrise view (image of the kneecap with a bent knee).
The three images provide enough details to avoid any wrong diagnosis. Think of it as the middle ground in knee imaging, more comprehensive than a one- or two-view study (CPT 73560) but less than a comprehensive four-view exam (CPT 73564). Additionally, a radiologist or an orthopedist must supervise the X-ray procedure.
This type of knee X-ray is common in orthopedic practices and labs, so you must learn how to use it correctly. Otherwise, you can lose a lot of revenue.
Scenarios Where CPT Code 73562 is Applicable
To clear the picture, let’s look at some scenarios in which a physician might order a three-view knee X-ray covered by CPT code 73562.
Sports Injury
Suppose a football player feels sudden knee pain during a match. Soon, the knee swells, and he struggles to maintain stability. He is rushed to the emergency room. The attending physician suspects that a torn anterior cruciate ligament (ACL) is compromising knee stability.
However, to confirm the diagnosis, the physician requests a 3-view knee X-ray to assess bone alignment and joint space. The results indicate a possible avulsion fracture. Hence, in this scenario, the X-ray can be billed via CPT code 73562.
Osteoarthritis Evaluation
Imagine that a patient with chronic knee pain, stiffness, and reduced mobility visits an orthopedic clinic. The patient is between 60 and 70 years of age and has a family history of joint disorders. The attending physician suspects that degenerative changes in the knee joint (osteoarthritis) are eroding cartilage and causing the visible symptoms.
A knee X-ray is ordered for confirmation. The physician requests 3 views to evaluate joint space narrowing and bone spurs. The results show advanced arthritis. So, CPT code 73562 will be applied to bill the X-ray.
Applicable Modifiers for CPT Code 73562
The following are some modifiers that you can use with CPT code 73562 when required.
| Modifier | Description | When to Use |
|---|---|---|
| 26 | Professional Component | Used when billing only for the physician’s interpretation and report. |
| 50 | Bilateral Procedure | Used when imaging of both knees occurs in the same session. |
| 59 | Distinct Procedural Service | Applied when the X-ray procedure is separate and distinct from other procedures performed on the same day. |
| TC | Technical Component | Applied when billing only for the technical aspects, including equipment, supplies, and the technician’s services. |
| LT | Left Laterality | Specifies that the imaging procedure was performed only on the left knee. |
| RT | Right Laterality | Specifies that the imaging procedure was performed only on the right knee. |
CPT Code 73562 – Billing & Reimbursement Guidelines
Want to prevent denials and payment reductions? Follow these key billing and reimbursement guidelines for CPT code 73562:
Provide Complete Documentation
You must justify the medical necessity of the procedure. Document everything that led to the ordering of a 3-view X-ray. Including:
- The patient’s medical history
- The patient’s current condition and symptoms
- Signed order of the physician for the scan
- X-ray results
- Any prescribed medications
Confirm the Medicare Reimbursement Rates
The reimbursement amount for CPT code 73562 varies for each MAC locality. The national average reimbursement amount for 73562 is $39.46 in non-facility settings.
The following is a more detailed breakdown of the cost structure:
- Professional component:
- Facility price: $8.73
- Non-facility price: $8.73
- Technical component:
- Facility price: Not applicable
- Non-facility price: $30.73
You can check the exact reimbursement rate for your MAC locality via the PFS Lookup Tool.
Wrapping Up
Here we come to the end of the detailed guide! Let’s summarize everything we have discussed so far.
CPT code 73562 represents a simple X-ray of the knee with 3 views. You must append comprehensive documentation and appropriate modifiers like LT, RT, 26, TC, and others to your claims for proper reimbursement.
Hopefully, this guide will become your go-to resource for billing knee X-rays. However, if you still find it challenging to achieve a high, clean claims rate, you can always connect with our billing experts for specialized radiology billing services.
