ED Coding and Reimbursement Alert

Question: A patient complaining of sore ribs and chest discomfort reports to the ED. After a level-three E/M, the physician performs a bilateral three-view rib x-ray and a single-view frontal chest x-ray. How should I report this scenario?

Arkansas Subscriber

Answer: You-ll be able to report an E/M code and a code for the rib x-ray, but you cannot code the chest x-ray separately.

Why? The Correct Coding Initiative (CCI) bundles chest x-rays (71010, Radiologic examination, chest; single view, frontal) into all of the rib x-ray codes. The only time you can report chest and rib x-rays for the same encounter is if the exams were separate services (such as during a different encounter). In your scenario, the x-rays are not separate services.

On the claim, report the following:

- 71110 (Radiologic examination, ribs, bilateral; three views) for the rib x-ray

- modifier 26 (Professional component) linked to 71110 to show that you are coding only for the physician's work on the patient, not for the x-ray equipment

- 99283 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem- focused history; an expanded problem-focused examination; and 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) linked to 99283 to show that the E/M and x-ray were separate services.