ED Coding and Reimbursement Alert

Follow these tips to 'x' out denials Your emergency department (ED) performs chest x-rays regularly, but you still can't always answer those nagging coding questions. Let our experts do it for you with these tried-and-true guidelines. Add Modifiers for Multiple Chest X-Rays Question: Can we report 71010 (Radiologic examination, chest; single view, frontal) more than once on the same date? For instance, we might perform two or three single-view chest x-rays if a patient has a pneumothorax and receives a chest tube.

Answer: One of the most important things to remember when billing multiple chest x-rays on the same day is to make sure your diagnosis code supports medical necessity -- and pneumothorax (512.x) clearly falls into that category. "Patients requiring intubation and then repositioning of the endotracheal tube will also frequently receive multiple chest x-rays," says Michael Granovsky, MD, CPC, FACEP, vice president of coding at MSRI in Stoneham, Mass. You should look for a diagnosis of respiratory failure or indications that the patient was intubated to tip you off to multiple x-rays, Granovsky says. In these situations, the ED physician must monitor the status of the patient's lungs so he can react immediately if anything should change.

The modifier is key: You should append modifier -76 (Repeat procedure by same physician) to the subsequent x-rays if the same physician interprets them. If a different physician interprets the follow-up x-ray, you should add modifier -77 (Repeat procedure by another physician).

Suppose a newborn has respiratory distress syndrome (769) and the physician orders two chest x-rays, six hours apart, to assess how well the infant's lungs are functioning. If your ED physician reads the first x-ray, you should report 71010. If a radiologist reads the subsequent x-ray, he should report 71010-77. Apply -76 and -77 to Matching CPT Codes Don't miss: If the ED physician performs a single-view chest x-ray and a radiologist performs a two-view chest x-ray, you should not append these modifiers to either code. Instead, you should report 71010 for the first x-ray and 71020 (Radiologic examination, chest, two views, frontal and lateral) for the second when performed on the same date of service.

However, if two different physicians report the same x-ray code on the same patient, you may need to append modifier -77 to inform payers that it was a repeat procedure by another physician (rather than two physicians billing for the same service). Be prepared to demonstrate medical necessity for both the second x-ray and interpretation.

If the same physician performed two chest x-rays, one before treatment and one after, you'd append modifier -76 in order to follow the same requirement for medical-necessity documentation.

Individual payers may set their own limits that determine how frequently you can report [...]