What codes cover an X-ray (x-radiation) of the hand after a fall with concern for a fracture?

X-ray Coding for Hand Fracture Evaluation After Fall

The appropriate CPT code for an X-ray of the hand after a fall with concern for fracture is 73120 (Radiologic examination, hand; 2 views), with additional views coded as 73130 (Radiologic examination, hand; minimum of 3 views). 1, 2

Appropriate Imaging Protocol for Hand Trauma

Initial Imaging Recommendation

• A 3-view radiographic examination is the recommended initial imaging study for suspected hand fractures 1, 2
• The three standard views include:
  • Posteroanterior (PA) view
  • Lateral view
  • Oblique (45° semipronated) view

Coding Structure

1. CPT 73120: Hand X-ray, 2 views
2. CPT 73130: Hand X-ray, minimum of 3 views (preferred for comprehensive evaluation)
3. ICD-10 Diagnosis Codes to pair with the CPT code:
   • S62.90XA: Unspecified fracture of unspecified wrist and hand, initial encounter
   • W19.XXXA: Unspecified fall, initial encounter

Evidence Supporting 3-View Protocol

The American College of Radiology recommends a standard 3-view examination for hand injuries to properly evaluate bone alignment, joint spaces, displacement, and angulation 1. Research has demonstrated that three-view radiographic examination significantly increases diagnostic accuracy compared to two views 2.

A 2023 study found that despite the proven superiority of 3-view examinations, less than half (45%) of patients with confirmed hand fractures received all three views 2. This highlights the importance of coding for and obtaining all three views when hand fracture is suspected.

Clinical Considerations for Coding

When Additional Imaging May Be Necessary

• If initial radiographs are negative but clinical suspicion remains high:
  • MRI without IV contrast may be indicated for detecting occult fractures 1
  • CT without IV contrast may be appropriate for complex fractures with intra-articular extension 1

Common Pitfalls in Imaging and Coding

• Failing to order all three views may lead to missed fractures
• Using only two views (typically PA and lateral) is insufficient for comprehensive evaluation 2
• The lateral view is most commonly missing in metacarpal fracture evaluations (38% of cases) 2
• The oblique view is most commonly absent in phalangeal fracture cases (64%) 2

Diagnostic Accuracy Considerations

Point-of-care ultrasound may be useful as an adjunct when X-rays are equivocal, but this would be coded differently and is not the standard first-line approach 3. The standard radiographic protocol remains the most appropriate initial diagnostic approach for suspected hand fractures.

Remember that anatomic snuffbox tenderness has been shown to be 100% sensitive and 76% specific for carpal navicular fractures, making appropriate imaging essential when this clinical finding is present 4.