ED Coding and Reimbursement Alert

Override CCI edits if doctor does x-rays pre- and post-diagnosis

You can avoid overcoding rib and chest x-ray procedures if you code based on these two guidelines.

Use 71100 for 2-View X-Rays

Suppose a patient with sore ribs reports to the ED. The ED physician conducts a two-view x-ray of one side of the rib cage and finds closed fractures on two ribs. On the claim, you would report the following:

- 71100 (Radiologic examination, ribs, unilateral; two views) for the x-ray
- modifier 26 (Professional component) linked to 71100 to show that you are only coding for the physician's work on the patient, not for the x-ray equipment
- 807.02 (Fracture of rib[s], sternum, larynx, and trachea; rib[s], closed; two ribs) linked to 71100 to prove medical necessity for the exam.

In addition to 71100, CPT has these codes for use on rib x-ray claims. Use them as the situation dictates:

- 71101--- including posteroanterior chest, minimum of three views
- 71110--...Radiologic examination, ribs, bilateral; three views
- 71111--- including posteroanterior chest, minimum of four views.

Observe CCI Bundles on Chest/Rib Exams

When you are reporting this x-ray service combination, watch out for Correct Coding Initiative edits, which forbid coding single-view chest x-rays and rib x-rays together except in rare situations.

The lowdown: CCI bundles 71010 (Radiologic examination, chest; single view, frontal) into 71100, 71101, 71110 and 71111. This means that you cannot report the single-view chest x-ray code and rib x-ray code on the same claim, unless you can show the payer that the exams were separate services.

Check out these examples:

Bundled example: A patient with rib pain reports to the ED. The ED physician performs a single-view chest x-ray and a two-view unilateral rib x-ray on the same date. When you are coding this scenario, you should report a rib-exam code, says Stacy Gregory, RCC, CPC, from Tacoma, Wash.-based Gregory Medical Consulting Services.

On the claim, report 71101-26 for the x-rays.

Explanation: -Both 71100 and 71101 include a view of the chest,- says Debra Ferenc, CPC, CPC-H, CMSCS, CMC, senior consultant and educator with MRCE. So proceed with caution when you think about reporting a single-view chest x-ray along with either of these rib exam codes.

Unbundled example: A patient has a fractured rib that has caused a pneumothorax. The ED physician performs a two-view rib x-ray. Six hours later, the physician performs a single-view chest x-ray to evaluate the pneumothorax.

In this scenario, you can unbundle the x-rays. They were done hours apart and for separate purposes. On the claim, report the following:

- 71100-26 for the rib x-ray
- 71010-26 for the chest x-ray
- modifier 59 (Distinct procedural service) appended to 71010 to show that the rib and chest exams were separate procedures.

However: This CCI edit only applies to single-view chest x-rays performed on the same date as rib x-rays. When coding for a two-view chest x-ray and a two-view unilateral rib x-ray, you don't need modifier 59. In these scenarios, report 71100 for the rib exam and 71020 (Radiologic examination, chest, two views, frontal and lateral) for the chest exam, Gregory says.