In podiatry, accurately billing for ankle radiographs hinges on selecting the correct CPT code and applying modifiers judiciously. CPT 73600 and 73610 each serve different clinical contexts and payer scenarios. This article clarifies when to use each, outlines supervised versus limited views, delves into modifier usage, and highlights payer policy considerations, especially for Medicare.

CPT Code Breakdown: 73600 vs. 73610

• CPT 73600 – Radiologic examination, ankle; 2 views.
  Used for basic imaging (e.g., AP and lateral)—typically when limited views suffice.
  
  
• CPT 73610 – Radiologic examination, ankle; complete, minimum of 3 views.
  Required for comprehensive evaluation (e.g., AP, lateral, mortise view).

Always select the code that best reflects the number of views taken and the diagnostic necessity.

Supervised vs. Limited Views in Practice

While coding doesn’t explicitly distinguish between “supervised” versus “limited” views, these concepts impact selection:

• Limited Views: If fewer than three views are taken, opt for 73600.
  
  
• Complete (Supervised) Series: For more thorough imaging involving three or more views, choose 73610 and document each view clearly.

Biomedical necessity must be well-documented, especially if opting for a more extensive study. Medicare, for instance, demands justification for a complete series versus a limited one.

Modifier Usage

Accurate modifier application prevents denials and clarifies billable components:

• -26 (Professional Component): Applies when only the provider’s interpretation is billed.
  
  
• -TC (Technical Component): Applies when only equipment/staff services are billed.
  
  
• Global Billing: No modifier needed when both components are rendered by one provider.
  
  
• -50 (Bilateral Procedure): Use when imaging both ankles—for example, code 73610 × 2 + modifier ‑50 on the second instance.
  
  
• -52 (Reduced Services): When a full 3‑view exam (73610) isn’t possible or performed, but billed—you may append ‑52 to indicate partial service. Alternatively, bill 73600 if that better reflects what happened.
  
  
• -LT / -RT: Specify laterality when applicable (e.g., right or left ankle) especially vital in musculoskeletal imaging.
  
  
• -59 (Distinct Procedural Service): Rarely used in ankle X-ray billing, but could apply if multiple distinct anatomical imaging studies occur at the same visit (used cautiously).
  

Payer Policies & Documentation Requirements

Medicare (and Many Payers)

• Require medical necessity, not screening imaging. Abnormal signs or established disease must justify the study.
  
  
• Compare studies (e.g., imaging contralateral side for comparison) are not inherently refundable unless medically necessary.
  
  
• For follow-ups or stable conditions, routine yearly X-rays may be reimbursable only with justification.
  
  

Reimbursement Trends

• Medicare reimbursements have declined. From 2005–2020 adjusted rates:
  
  
  • 73600 down ~12.4% (unadjusted) and ~29.2% (professional component)
    
    
  • 73610 down ~10.8% (unadjusted) and ~35.3% (professional component)

Private Payers & Facility Rates

• Pricing varies widely: standalone imaging centers may charge ~$89.52 (73600) vs. ~$101.43 (73610), while hospital outpatient settings often charge significantly more.
  
  
• Patients and practices report dramatic cost differences depending on setting—non-hospital settings typically far cheaper.
  

Best Practice Guidelines—Summary Table

Takeaways

Proper coding between 73600 and 73610 depends on clinical detail: number of views, laterality, diagnostic need, and payer context. Use modifiers strategically to mirror the nature of service rendered. Robust documentation, especially for medical necessity and view specifics, underpins successful reimbursement and compliance.