Medicare Compliance & Reimbursement

However, by including the specific types of views in the documentation, the provider is also listing the number of views. This is what Felt refers to as the “gold standard” of documenting types of views. When the provider documents the types of views, they are protected if the procedure code requires a specific view, and the provider is also documenting the number of views, so you can accurately assign the correct CPT^® code.

Recorded images: Providers are required to permanently record images and place them in the patient record. You can review the recorded images to see what views the radiologist captured, which can verify the quantity of views listed in the medical record.

Understand the Common X-Ray Views

Radiologists use different X-ray views when imaging the patient’s body. The distinct views allow the provider to rule out or diagnose the patient’s condition with the best view possible.

Below is a refresher of some of the common X-ray views:

• AP: X-ray beams enter the body structure through the anterior (front) and exit through the posterior (back).
• PA: X-ray beams enter the body structure through the posterior and exit through the anterior.
• Oblique: The patient is positioned at a 45-degree angle to the left or right to capture images. This view is ideal for imaging the sternum and ribs.
• Lateral: The patient is positioned perpendicular to the X-ray beams, so the radiologist can capture side images.
• Bending: The patient stands up straight and the radiologist instructs the patient to either bend forward (flexion) or backward (extension) from the lower back.

These definitions will help you identify the view types when counting the number of views to assign the correct imaging procedure code.

Know Which Codes Require Specific Views

While the X-ray procedure codes specify the number of views required to report the codes, the CPT^® code set also includes codes whose descriptors do require specific views for reimbursement.

For example, the following lumbosacral X-ray procedures require bending views of the spine:

• 72114 (Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views)
• 72120 (… bending views only, 2 or 3 views)

Scenario: A patient presents to your radiology practice with lower back pain. The radiologist captures AP, PA, lateral, oblique, flexion, and extension views.

For this scenario, you’ll assign 72114 to report the X-ray procedure. The provider captured six views, including the bending views, which are documented by “flexion” and “extension” views.

“Doctors are using anatomical terms. They’ll say, ‘in flexion’ or ‘in extension’ — those are bending views,” Felt noted.

However, if the radiologist captured AP, PA, lateral, and oblique views, then you’d assign 72110 (… minimum of 4 views) since the provider didn’t capture the bending views.

Bottom line: Even though the CPT^® code descriptors specify the number of views, you need to stay on your toes and carefully review all medical documentation to make sure you have the information needed for the correct code selection.