Forearm X-ray (both sides)

What it is

The forearm holds two bones — the radius and the ulna — linked at both ends and along their length, and turning the palm up and down depends on one of them rotating around the other. That linkage is why a forearm film is read differently from a film of a single bone. When one of the two breaks, the force usually has to go somewhere else as well, either into the second bone or into the joint at one end, so the study is taken to show the shafts together with the elbow and the wrist at their ends. In adults, a fall or a direct blow hard enough to break one bone quite often breaks both. This code is the two-view study, billed here for both forearms.

Why it is done

• To identify a break in one or both forearm bones after a fall, a direct blow, or a collision
• To show whether the second bone is also broken, or whether the joint at the elbow or wrist end has been disrupted alongside a single-bone break
• To measure angulation and rotation, which matter more here than in most bones because a forearm that heals twisted loses the ability to turn the palm
• To follow a fracture in a cast, where the two bones can shift relative to each other as swelling settles
• To check the position of plates, screws, or a rod after a repair

What to expect

The forearm is laid flat on the plate, palm up, for the first view and turned on its side for the second; the technologist steps behind a screen for each. A splinted or casted arm is imaged through the cast rather than unwrapped. Positioning a recent injury is the sore part. The visit is short and nothing is needed beforehand or afterward. A radiologist issues the formal reading, and in a fracture clinic the surgeon reviews the images at the same visit.

Questions worth asking

• The study is meant to take in the elbow and wrist ends of the forearm. If dedicated elbow or wrist x-rays were also taken, are those billed as additional studies?
• Were both forearms actually imaged? A both-sides code on a one-sided injury is worth asking about.
• Films are usually repeated after a fracture is set or casted. Is the repeat study on the same day billed again, or included?
• If the arm is imaged through a cast and the images are hard to read, is a repeat set after cast removal a new charge?