You can use CPT code 73030 for services when the physician performs a radiologic examination of the whole shoulder with a minimum of two views.
Description Of CPT Code 73030
The following are the reasons why the physician performs CPT code 73030:
- Benign bone tumors.
- Bone cancer.
- Broken bones (shoulder fractures).
- Dislocated shoulder.
- Problems with the alignment of the shoulder joint.
- Rotator cuff calcifications (buildup of calcium on the rotator cuff tendon).
- Rotator cuff tears.
The official description of the 73030 CPT code is: “Radiologic examination, shoulder; complete, minimum of 2 views.”
The physician performs radiologic imaging of the shoulder, which transfers electromagnetic wave radiation through the patient’s body. These waves generate a scan on an X-ray film or a digital sensor.
The physician may take a broad series of shoulder images to detect disformity. These images show white bones on X-ray as radiation cannot emit through the bones. The muscles or other tissue may appear black or gray because some waves can pass through.
The physician may need other studies as well, in addition to should x-ray, to determine the root cause of the problem, such as Magnetic resonance imaging (MRI), Ultrasound, CT (computed tomography) scan,
The shoulder comprises of following joints, and a physician may perform an x-ray to view these joints:
- ball-and-socket joint;
- the scapula (shoulder blade) that connects to the humerus;
- humerus (upper arm bone); and the
- acromion (a piece of bone that projects off the scapula).
The clavicle (collarbone) relates to the acromion Coracoid process (a hook-shaped part of the bone that projects off the scapula).
The nerves, cartilage, muscles, and tendons may not be visible on an X-ray but are significant in identifying the position and shape of your bones when performed by the physician.
The patient is supine with the arm extended to a 90-degree angle from the body, and the physician rotates externally while the head is turned to face opposite the affected side. The physician takes the film of the shoulder. CPT code 73020 is appropriate to report when one view of the shoulder performs by the physician. In contrast, the 73030 CPT code bills for at least two views.
A maximum of one unit can be a bill on the same service date of CPT code 73030. In contrast, three units are allowed when documentation supports the medical necessity of the service.
The cost and RUVS of CPT code 73030 with modifier 26 are $10.04 and 0.29021 when performed in the facility. In contrast, the reimbursement and RUVS of 73030 CPT code with modifier 26 are $10.04 and 0.29021 when performed in the non-facility. In OPPS global, the cost and RUVS of CPT 73030 with modifier 26 are 10.04 and 0.29021.
The cost and RUVS of CPT 73030 with modifier TC are $30.76 and 0.88882 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 73030 with modifier TC are $30.76 and 0.88882 when performed in the non-facility. In OPPS global, the cost and RUVS of CPT code 73030 with modifier TC are $96.75 and 2.79571.
In OPPS global, the cost and RUVS of CPT 73030 with a global modifier are $106.79 and 3.08592. The cost and RUVS of CPT 73030 with global billing are $40.80 and 1.17903 when performed in the facility. In contrast, the reimbursement and RUVS of 73030 CPT code with global billing are $40.80 and 1.17903 when performed in the non-facility.
The physician can perform a minimum number of views or more views when needed to complete the study Radiographs are adequately repeated during encounters due to substandard quality. Only 1 unit bills, according to the description, only one unit bills if the physician furnishes multiple studies.
The physician may Obtain more films after the initial film review, based on the radiologist’s discretion, order for the test, and change in the patient’s condition.
If the physician uses a second interpretation by requesting a physician (included in E/M service), reporting separately with CPT code 73030 is inappropriate.
It is appropriate to report Stress views upper body joint(s) with CPT code (77071) when performing in addition to CPT 73030.
These are unilateral procedures. Some payers require that the service be reported twice with modifier 50 appended to the second code if performed bilaterally. In contrast, others require identification of the service only once with modifier 50 appended.
Check with individual payers. Modifier 50 identifies a procedure performed identically on the opposite side of the body (mirror image). The Insurance may require LT and RT modifiers for the bilateral procedure.
CPT code 73030 has both a technical and professional component. Attaching TC with technical components and 26 with the professional component is appropriate.
HCPCS codes R0070, and R0075 are applicable when the Phyciscan uses portable x-ray equipment and personnel transportation during the procedure. Check your payer guideline to see if these services are covered. For stress views of the shoulder, see 77071.
A 60-year-old female presents with shoulder osteoarthritis and has had pain for four days in the office. The pain gets worse with movement and when lying down. The patient took some medication for pain.
The X-ray shows degeneration of the shoulder joints and effusion in both shoulders. The patient also has tendonitis in the shoulder region. The patient denies other symptoms, such as headache, numbness, urinary problems, nausea, vomiting, and shortness of breath.
The physician administers the steroid injection in the joint space for pain management.
Because the physician ordered an X-ray with two views, CPT code 73030 was billed.