Collarbone (Clavicle) X-ray (both sides)

What it is

The clavicle is the strut that holds the shoulder out from the chest. It is long, thin, curved, and directly under the skin, which is why a broken one often shows as a visible bump before any imaging is done. The film is not really being taken to answer whether it is broken; it is being taken to measure the break. A crack in the middle of the bone with the ends still lined up is treated very differently from one where the ends have overridden each other and the bone has effectively shortened. The film also shows breaks at the outer end, close to the shoulder joint, where the ligaments that hold the bone down change how the fragments behave. This code is the complete study of the collarbone, billed here for both sides.

Why it is done

• To measure a collarbone fracture — where along the bone it sits, how far the ends have separated, and whether the bone has shortened
• To distinguish a break near the outer end from one in the middle, because the two behave differently and are managed differently
• To check that a fracture being treated in a sling has not drifted further out of line during the first weeks
• To confirm the position of a plate and screws, or of pins, after a repair
• To image both collarbones when the injury involved a fall or collision that could have caught both sides, or when the uninjured side is wanted as a reference

What to expect

The patient usually sits or stands facing the machine with the shoulders relaxed, and a second image is taken with the beam angled upward so the bone is not lying flat against the ribs behind it. Positioning takes moments and the whole visit is short. A freshly broken collarbone is sore to hold still, and the technologist will work around that rather than move the arm. Nothing is required beforehand. A radiologist reads the study and reports it; in a fracture clinic the treating surgeon usually looks at the images immediately as well.

Questions worth asking

• Was this billed as one both-sides study or as two separate one-sided studies? The bilateral code exists, and two unilateral charges for the same visit are worth questioning.
• If only one collarbone was injured, why were both imaged, and was the second side ordered or added by the department?
• Is the x-ray part of the emergency department or urgent care visit charge, or a separate line with its own facility component?
• If surgery follows, are the x-rays taken in the operating room or the recovery area folded into the surgical charge or billed on their own?