ED Coding and Reimbursement Alert

Question: A woman who fell on her unprotected side reports to the ED. The physician notes that the patient had "the beginnings of a contusion to her right abdominal wall upon reporting." During the examination, she reports shortness of breath, and says the pain is a 6 on a scale of 10. To rule out broken ribs, the physician orders a rib xray. The x-rays reveal no broken bones, so the physician orders the patient to rest a few days and prescribes painkillers. Final diagnosis is abdominal wall contusion, and notes indicate a level-three E/M in addition to the xray. What is the proper code for the x-ray?

Kentucky Subscriber

Answer: It depends on the type of x-ray your physician performed. Go back and check the notes - or ask the physician who ordered the x-rays. There are four different CPT codes for rib x-rays:

• 71100 (Radiologic examination, ribs, unilateral; 2 views)
• 71101 (... including posteroanterior chest, minimum of 3 views)
• 71110 (Radiologic examination, ribs, bilateral; 3 views)
• 71111 (... including posteroanterior chest, minimum of 4 views).

So let's say that the physician ordered a unilateral twoview rib x-ray. On the claim, you'd report the following:

• 71100 for the x-ray
• Modifier 26 (Professional component) appended to 71100 to show that you are only coding for the physician's interpretation services on the x-ray
• 922.2 (Contusion of trunk; abdominal wall) appended to 71100 to represent the patient's injured abdomen
• 99283 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of moderate complexity ...) for the E/M
• Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99283 to show the x-ray and E/M were separate services
• 922.2 appended to 99283 to represent the patient's injured abdomen
• 786.05 (Symptoms involving respiratory system and other chest symptoms; dyspnea and respiratory abnormalities; shortness of breath) appended to 99283 to represent the patient's shortness of breath.