# Chest X-Ray and Clavicle X-Ray - Level 3 or 4 for the Facility



## Pvdcoder (Jun 8, 2016)

Hi, does anyone know if a chest x-ray and clavicle x-ray are considered 1 Body Area or 2?  CPT 99283 states X-Ray of 1 while CPT 99284 states 2 or more so I wanted to get clarification on what level for the facility we should charge.  Any guidance would be appreciated.  Thank you.


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## mitchellde (Jun 8, 2016)

A facility E&M is based on a set of criteria established by the facility.  You cannot use the physician guidelines.  For X-rays you need to use the specific X-ray codes.  From your post it is not clear what you are trying to for.


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## CodingKing (Jun 8, 2016)

I assume you facility uses the Body areas as per the E&M DG's 


Clavicle is a bone in the chest area. So sounds like one body area to me

Body areas are:


Head, including the face
Neck
Chest, including breasts and axillae
Abdomen
Genitalia, groin, buttocks
Back, including spine
Each extremity


For what level i cant tell you as each facility is different.


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## mitchellde (Jun 8, 2016)

Facility levels do not usually go by body areas they go by utilization of resources.  Most use a point system, such as taking vitals is 5 points ( utilization of nursing staff time) or taking a patient to the radiology department ( utilization of patient transporter time) and so on.  So it would be unusual for body areas to be a consideration for a facility level.
In the post it is stated "CPT 99283 states X-Ray of 1 while CPT 99284 states 2 " I am not at all sure what is meant by this as these are ER visit levels and are not based on X-rays.


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## CodingKing (Jun 8, 2016)

I was just as confused as I though the same, resource utilization (Ive been too busy to work on my COC training  ). I was looking at the ACEP's ED Facility Level Coding Guidelines and it seemed to follow along with the the poster was talking about. I'm still lost though. 

https://www.acep.org/content.aspx?id=30428


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## Pvdcoder (Jun 8, 2016)

Sorry for the confusion everyone and thank you for your responses.  My question means, if a patient comes to the ED for say pain in the clavicle and the doctor orders a chest x-ray and a x-ray of the clavicle.  

According to the ACEP facility guidelines the bulleted points in the section for CPT 99283 states Interventions from previous levels plus any of the following can include Preparation for 1 Diagnostic Test: EKG, LAB Tests described in CPT 80048-87999 or Plain X-Ray of only 1 area such as Hand, shoulder and pelvis.  CPT 99284 states Preparation of 2 Diagnostic Tests Lab, EKG or X-Ray of Multiple Body Areas such as C-Spine & Foot, Shoulder & Pelvis.  So would the order of those 2 X-Rays be considered 1 area or 2?  

Hope this helps clarify my question a bit better, thanks again everyone.


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## mitchellde (Jun 8, 2016)

Always remember for facility it is the resources used by the facility that count not what the physician ordered or looked at.  So when the guidelines referenced state preparation for the X-ray, they are referring to what the facility needed to do for the X-ray to take place.  Like I suggested previously. A patient transporter to take the patient to the radiology department or a staff member to bring a portable X Ray to the ER.  Your facility needs to have a set of facility guidelines that you can follow for this.  Like I said many use a point system.


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