Radiology Coding Alert

Radiologists report 71010 more frequently than any other code -- make sure that your practice reports it correctly

Although radiologists routinely report 71010 (Radiologic examination chest; single view frontal) chest x-ray coding can still challenge even the most seasoned radiology practices. Secure reimbursement for these procedures with the following expert answers to your most pressing chest x-ray questions.

Add Modifiers for Multiple Chest X-Rays

Question 1: Can we report 71010 more than once on the same date? For instance we might perform four or five single-view chest x-rays if a patient has a pneumothorax from a CT-guided (computed tomography) biopsy.

Answer: One of the most important things to remember when billing multiple chest x-rays on the same day is to make sure that your diagnosis code supports medical necessity - and pneumothorax (512.x) clearly falls into that category. The physician must monitor the status of the patient's lungs so he can react immediately if anything should change.

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 append modifier -77 (Repeat procedure by another physician).

Suppose a newborn has respiratory distress syndrome (769) and the neonatologist orders two chest x-rays six hours apart to assess how well the infant's lungs are functioning. The radiologist who reads the first x-ray should report 71010. If a separate radiologist reads the subsequent x-ray he should report 71010-77.

Apply -76 and -77 Only to Matching CPT Codes

Don't miss: If the first radiologist performs a single-view chest x-ray and the second radiologist performs a two-view chest x-ray you should not append these modifiers to either code. Instead you should report 71010-59 (Distinct procedural service) 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.

Modifiers -76 and -77 only apply "when the same procedure (e.g. the same CPT code) must be repeated in a different session during the same day " says Laura Siniscalchi RHIA CCS CCS-P CPC manager at the healthcare and life sciences regulatory practice at Deloitte and Touche.

Individual payers may set their own limits that determine how frequently you can report follow-up chest x-rays for pneumothorax and some payers may try to bundle the subsequent x-rays. If this happens resubmit the claim with copies of each of the chest x-ray reports. In addition you should always document the time of day when you perform each x-ray.

Rib X-Ray? Choose 71100 Instead of 71020

Question 2: We typically report 71020 for two-view rib x-rays. An auditor we hired said that this is incorrect. What are we doing wrong?

Answer: Reporting 71020 is incorrect coding in this case because CPT includes several more specific rib x-ray codes. You should report 71100 (Radiologic examination ribs unilateral; two views) for a two-view rib x-ray. Although the ribs and chest encompass the same portion of the body they are distinct procedures.

You'll often report a chest x-ray code when you assess soft tissue structures within the rib case for conditions such as bacterial pneumonia (482.x) or a neoplasm (162.3 Malignant neoplasm of trachea bronchus and lung; upper lobe bronchus or lung).

You'll report the rib x-ray codes (71100 -71111) if you study the bony structures for conditions such as trauma (for instance a fracture sustained in a car accident [807.0x Fracture of ribs closed]) or intractable rib pain.

Tip: The National Correct Coding Initiative bundles 71010 into 71100 and you can report these codes separately only if you append a modifier and explain why you assigned both codes. For instance you might perform a rib x-ray during an initial emergency department encounter if a patient has a rib fracture that caused a pneumothorax. Several hours later you might perform a single-view chest x-ray to determine the status of the pneumothorax. In this instance you should report 71100 and 71010-59 (Distinct procedural service).

Pre-Op X-Ray Pay Requires Correct Dx Order

Question 3: Anesthesiologists often ask us to perform preoperative chest x-rays for their patients but we're seeing that payers don't usually reimburse us for these. What are we doing wrong?

Answer: Many payers reimburse preoperative chest x-rays only if your patient has a cardiopulmonary history says Cheryl Schad BA CPCM CPC owner of Schad Medical Management a medical reimbursement consulting firm in New Jersey. "Even if the surgeon finds a cardiopulmonary problem during the surgery your carrier may not pay for the preoperative x-ray " she says.  

In most cases the patient's cardiopulmonary history must already be documented in the carrier's database before you perform the preoperative x-ray or the insurer may not pay.

The next step: Suppose a patient has had emphysema (492.x) for three years and the physician feels that he qualifies for a preoperative chest x-ray to assess the status of this existing disease process. Make sure that you list your diagnosis codes in the correct order or you'll risk a swift denial.

If the practice performs a preoperative screening x-ray the "V" code that describes the preoperative x-ray should go first followed by the reason for surgery says Paulette Stone CPC RCC quality-assurance specialist at the Public Employees Health Program in Utah.

V Codes Don't Apply to Diagnosed Conditions

Tip: The radiologist should also list any definitive findings as a third diagnosis code Schad says.

If the patient is scheduled for a chest x-ray to assess the status of a known condition you should report the known condition as your first diagnosis code followed by the ICD-9 codes that represent the findings. The V code does not apply if the patient has a condition that has already been diagnosed.

The V codes that radiologists most frequently report for preoperative chest x-rays follow: