Xrays of the knees-ap-lateral and standing views.

Our orthopedic surgeons continue to indicate we should bill 73564 right or left, whichever applies and 73565-both knees standing. We are getting the 73565 denied. I would expect that, as the descriptor for code 73564 is for "4 or more views". Would I be correct in not billing 73565 at all, or should I bill with a modifier-59, since it is both knees and 73564 is only for one knee? Your help would be greatly appreciated.
Mary.

73564 vs 73565

X-ray studies of the knees are often performed in a prone or supine position, where the patient is lying or sitting on the table. Codes for images obtained in this manner are relatively straightforward: 73560 (radiologic examination, knee; one or two views), 73562 (... three views) and 73564 (... four or more views). However, coders may be confused when one of these studies is performed with an x-ray done while the patient is upright (73565, ... both knees, standing anteroposterior).

Coding experts note that when obtained during the same session as other views, the standing views would not be reported as a separate service. Instead, they would be included in the total number of views obtained during the session. For instance, if AP views of both knees are obtained in the erect position and lateral views are obtained in the supine position, coders would assign the code for two views of each knee (two units of 73560 with the bilateral modifier). It would be incorrect to report a single view of the right knee, a single view of the left knee (again, two units of 73560 with the bilateral modifier) and 73565. Code 73656 should be used when only an AP upright view of both knees is obtained.

Source - www.osslogin.com

Hope this helps!!!

Bhavani

Xrays standing views

Thank you for your comment. It did help to clarify the situation. The docs told me that the situation is exactly as you described; the 4 view 73564-is being taken in the sitting or supine position. The 73565 is the standing view. According to what you describe, the proper coding scenario would then be 73560-50 and 73565-59. Is that correct?

Thank you for your response.

re: 73564 vs 73565

Good Morning
I have always struggle with the fact that counting one view of the right knee and one view of the left knee for a 73565 would be unbundling because the code is a bilateral code. Could you provide more clarification?

re: 73564 vs 73565

73565 – radiologic examination, both knees, standing, anteroposterior. 73565 is
used for a standing weight bearing view of both knees when form and structure is
examined. (Both knees will be on same film.) This is performed typically on patients with osteoarthritis and for presurgical planning. This code should be reported when the anteroposterior (AP) standing view is the only view taken. This is a matter of contention when also billing code 93564.
https://www.q2a.com/Portals/0/Referral%20PDFs%2003022012/1-765778336.pdf