Radiology Question for the Week of November 23, 2015

Question:

Question 

The description for CPT code 73540 indicates that assignment is appropriate for an infant or child. What age does a person stop being considered a child?  

73540 Radiologic examination, pelvis and hips, infant or child, minimum of 2 views

The descriptors for codes 73592 and 73092 indicate the procedure codes are for an infant, which I believe is less than 366 days old. Is that correct?

73092 Radiologic examination; upper extremity, infant, minimum of 2 views 

73592Radiologic examination; lower extremity, infant, minimum of 2 views  

Answer

The American Medical Association (AMA) identifies an infant as less than one year.  Some payers identify an infant as 365 days or less, others less than 365 days. 

A child is not clearly defined at all. In the preventive services evaluation and management CPT codes for 2014, the AMA defines a child as being up to 11 years, and an adolescent as 12 to 17 years of age. Payers have defined a child as being up to 11, up to 12, up to 17, etc. While there does not seem to be a universal definition, the most common definition of a child is 1 to 12.

Answer: