# billing chest xray after u/s guided PICC placement



## icoutin (Dec 29, 2009)

Can a chest xray (71010) to confirm positioning be billed after an ultrasound-guided PICC placement (36569, 76937)?  No fluoro was used/ documented.
I see plenty of literature indicating that 71010 is included in the fluoro and that both fluoro and the guidance can be billed if they are both documented and u/s is reported and recorded.  How about if only U/S guidance was used, and cxr is ordered and done to confirm catheter placement?

PS:  I don't see a CCI edit.....

Thanks for all your help!

Isela Coutin, CPC, CCS
Miami


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## AuntJoyce (Dec 29, 2009)

*Chest x-ray > PICC placement*

Hi Isela,

When I coded PICC lines, our docs ALWAYS did a chest x-ray regardless of whether they used fluoro or not.  When fluoro was used, we were denied the chest x-ray.  When no fluoro was used, we always got paid for the chest x-ray.

It's kind of 6 of one, half a dozen of the other.

Good luck!

Happy Holidays!

Joyce


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## icoutin (Dec 29, 2009)

*Thanks for your help!*

Sounds about right.... !  Thank you so much Joyce!

Happy Holidays to you as well, and a happy New Year!!!


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## AuntJoyce (Dec 30, 2009)

My pleasure...anytime


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## coder16 (Jan 5, 2010)

*chest x-rays after PICC line insertion*

I've been told by a couple of sources that a 52 modifier needs to be applied to a chest x-ray (one view) to check PICC line location.  However, our billers are telling me they are getting rejections because of the 52 modifier.

Is this true that it should be applied and how about chest tube locations?  Should they also have the 52 modifier applied?

Thanks for your help!

Jennifer


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## AuntJoyce (Jan 5, 2010)

*Chest x-rays after PICC line insertion*

I think that use of the -52 modifier is absolutely incorrect in this situation.  The bottom line is that doing a chest x-ray to confirm the position of a placed PICC line and to confirm position later on as well lies with each payer.  Some will allow it and pay it and others stand firm and deny, deny, deny.

Because it is payer specific and not an outright "no-no", for the sake of uniformity, I bill it on every occasion and write off the ones where they tell us that it is not a covered service.

Bear in mind that according to CMS CCI edits, you CAN append the -59 modifier...so...it again becomes a payer specific denial (or approval).

Hope this helps!


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## coder16 (Jan 6, 2010)

Thank you for very much for your response - Terry Leone is the one who provided the info and I thought it sounded a bit off.  

Jennifer


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