X-ray ankle, minimum 3 views
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Ottawa Ankle Rules not met - imaging not indicated
CommonAnkle X-ray should follow Ottawa Ankle Rules to avoid unnecessary imaging. Rules: X-ray indicated if (1) bone tenderness at posterior edge/tip of lateral or medial malleolus, OR (2) inability to bear weight immediately and in ED. Imaging without meeting these criteria may be denied.
Common Causes
- • Ankle sprain without bone tenderness at malleoli
- • Patient able to bear weight - Ottawa rules not met
- • Soft tissue injury without clinical concern for fracture
Resolution Strategy
Appeal with documentation meeting Ottawa Ankle Rules (bone tenderness at malleoli, inability to bear weight for 4 steps). If soft tissue injury without bony tenderness or weight-bearing limitation, denial may be upheld. Ottawa Rules reduce unnecessary ankle imaging by ~30%.
2. Should bill 73600 (2 views) - 3 views not necessary
Occasional73610 requires minimum 3 views (AP, lateral, mortise). If only 2 views obtained or documented, payers downgrade to 73600. Standard ankle series is 3 views, but some providers obtain only 2.
Common Causes
- • Only AP and lateral views obtained (missing mortise view)
- • Billed 73610 but documentation shows 2 views
- • Portable X-ray with limited views
Resolution Strategy
Verify actual views obtained and documented. If 3+ views truly performed, appeal with imaging report. If only 2 views, downgrade to 73600 appropriate.
Relative Value Units (RVUs)
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Clinical Information
When to Use
Ankle X-ray with minimum 3 views (AP, lateral, mortise) for ankle injury or pain - most common lower extremity imaging
Common Scenarios
Documentation Requirements
- Clinical indication (mechanism of injury, Ottawa Ankle Rules if applicable)
- Views obtained (must be at least 3 views - AP, lateral, mortise)
- Physical exam findings (tenderness, swelling, ability to bear weight)
- Radiologist interpretation
Coding Guidelines
Common Modifiers
Bundling Rules
- Must have minimum 3 views (AP, lateral, mortise) - standard ankle series
- Includes all 3 views - bill once, not per view
- If fewer than 3 views, use 73600 (ankle 2 views)
Exclusions
- Do not bill if fewer than 3 views obtained (use 73600)
- Cannot bill with 73600 same encounter
Coding Notes
Clinical scenarios
- Clinical indication (mechanism of injury, Ottawa Ankle Rules if applicable)
- Views obtained (must be at least 3 views - AP, lateral, mortise)
- Physical exam findings (tenderness, swelling, ability to bear weight)
- Clinical indication (mechanism of injury, Ottawa Ankle Rules if applicable)
- Views obtained (must be at least 3 views - AP, lateral, mortise)
- Physical exam findings (tenderness, swelling, ability to bear weight)
- Clinical indication (mechanism of injury, Ottawa Ankle Rules if applicable)
- Views obtained (must be at least 3 views - AP, lateral, mortise)
- Physical exam findings (tenderness, swelling, ability to bear weight)
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Code Details
Medicare Pricing
PFSRVU Breakdown
OPPS Details
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Ask a QuestionFrequently Asked Questions
CPT 73610 is the billing code for "X-ray ankle, minimum 3 views". Ankle X-ray with minimum 3 views (AP, lateral, mortise) for ankle injury or pain - most common lower extremity imaging
Medicare pays approximately $35.26 for CPT 73610 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
CPT 73610 has a total RVU of 2.28, broken down as: Work RVU 0.42, Practice Expense RVU 1.77, and Malpractice RVU 0.09. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 73610 is "Ottawa Ankle Rules not met - imaging not indicated". Ankle X-ray should follow Ottawa Ankle Rules to avoid unnecessary imaging. Rules: X-ray indicated if (1) bone tenderness at posterior edge/tip of lateral or medial malleolus, OR (2) inability to bear weight immediately and in ED. Imaging without meeting these criteria may be denied. Common causes include: Ankle sprain without bone tenderness at malleoli; Patient able to bear weight - Ottawa rules not met. Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 73610 include: Clinical indication (mechanism of injury, Ottawa Ankle Rules if applicable); Views obtained (must be at least 3 views - AP, lateral, mortise); Physical exam findings (tenderness, swelling, ability to bear weight); Radiologist interpretation. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 73610: Must have minimum 3 views (AP, lateral, mortise) - standard ankle series. Includes all 3 views - bill once, not per view Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 73610 include: 26 (Professional component), TC (Technical component), LT/RT (Left or right ankle). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 73610 is 15-20 minutes for 3-view acquisition. Time-based codes require documentation of the actual time spent providing the service.