Outpatient Facility Coding Alert

Learn how to navigate between parenthetical notes and other authoritative sources.

Sometimes, even the most basic clinical coding scenarios can prove problematic beneath the surface. That’s certainly the case when it comes to the prospect of coding a single-view chest X-ray and single-view abdominal X-ray at the same encounter. Most coders might think, these are two of the most basic radiology codes available, how challenging can this be?

As you’ll see, there’s more to the story than what immediately meets the eye. That’s because, in order to reach the correct answer, you’ll have to navigate between varying sets of conflicting information.

Have a look at the problem — and subsequent solution — to this deceivingly challenging X-ray coding example.

I.D. the Problem in this Coding Scenario

Example: The provider performs a single view of the abdomen and a single view of the chest at the same patient encounter.

At first glance, you might want to consider coding these services separately using the following two codes:

• 71045 — Radiologic examination, chest; single view
• 74018 — Radiologic examination, abdomen; 1 view.

However, upon further examination, you will see that a combination code exists that includes X-ray imaging of the chest and the abdomen:

• 74022 — Radiologic examination, abdomen; complete acute abdomen series, including supine, erect, and/or decubitus views, single view chest.

Before going any further, you might not yet see where the problem arises. After all, code 74022, on the surface, does not appear correct when you are reporting a single-view chest with a single-view abdomen. Furthermore, the Coding Strategies Navigator for Diagnostic Radiology states that the three following components must be met in order to code as an acute abdomen series:

• “Supine AP view of the abdomen (KUB or flat plate);
• “Upright (erect) PA view and/or a decubitus view of the abdomen;
• “PA upright view of the chest.”

With this information at hand, the answer to code each service individually as 71045 and 74018 seems relatively straightforward, right? Not so fast. Have a look at the parenthetical note listed under 71045:

• “For acute abdomen series that includes a single view of the chest and one or more views of the abdomen, use 74022.”

In other words, this note instructs you to report code 74022 for any encounter that involves a single chest X-ray in addition to a single, or multiple, abdominal X-rays. While you might think that these instructions are seemingly clear-cut, you’ve got to refer back to the description of a “complete abdominal series” to understand where the problem arises. If a complete abdominal series includes, at the very least, two abdominal views, you might be left scratching your head at this set of contradicting information.

You might suspect that based on the parenthetical note under 74018, a National Correct Coding Initiative (NCCI) edit might exist that prevents you from reporting 71045 and 74018 together. However, no such edit exists. Interestingly, the edit did exist during the first quarter of 2018, but that was rescinded as of April 1, 2018 due to efforts of the American College of Radiology (ACR) and Correct Coding Solutions (CCS). That means that you’ve got to make a decision as to which set of guidelines to obey. You can choose to follow one of two sets of information:

• That an acute abdominal series (74022) includes a single chest view with two or more abdominal views (via Navigator for Diagnostic Radiology guidelines) or;
• That an acute abdominal series includes a single chest view with one or more abdominal views (via 74018 parenthetical note guidelines).

Code Description Trumps Parenthetical Notes, for Now

In order to make a determination of the correct route, you should first have a look back at the code description for 74022.

“The code description for 74022 says ‘supine, erect and/or decubitus.’ That seems to infer that you need two or more views,” says Kimberly M. Fifer, CPC, CEDC, manager of coding operations at Revenue Cycle Management in Roanoke, Virginia. “To me, the actual code description of 74022 trumps the parenthetical note under 74018, but this should have been addressed by some authority before now,” Fifer relays.

“I also think you have to go with the 74022 code description documented in the CPT® manual,” says Lindsay Della Vella, COC, medical coding auditor at Precision Healthcare Management in Media, Pennsylvania. “A single-view abdomen and single-view chest is not an acute abdomen series according to the 74022 code description,” Della Vella explains.

General consensus aside, you should not consider the parenthetical note when coding single-view chest and single-view abdomen X-rays until an authoritative source, such as the CPT® Assistant, makes an official determination. Until then, follow the 74022 code description and instructions in the Navigator for Diagnostic Radiology, which explains that 74022 must include at least two abdominal views in addition to a single chest view.

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