Radiology Coding Alert

Understand the differences between 74019 and 74022.

Occasionally, you’ll receive a coding case that seems simple on the surface but leaves you scratching your head. That may be the situation when you need to code a single-view chest X-ray and a multiple-view abdominal X-ray during the same encounter.

Look at the scenario below, and then dive into the solution to understand this perplexing coding occurrence.

Examine The Coding Example

Scenario: A patient presents to an outpatient radiology clinic for X-rays of their chest and abdomen. The patient was recently involved in a motor vehicle accident and has been experiencing sharp pains in the chest and abdomen since the event. The radiologist first captures an anteroposterior (AP) chest X-ray, followed by a complete abdomen series with supine and decubitus X-ray views.

Now that you’ve reviewed the scenario, learn your coding options for this unique situation.

Know When You Need 1 Code or 2 Codes

Upon an initial review of the scenario presented above, you might consider reporting the X-ray services separately using the following CPT^® codes:

• 71045 (Radiologic examination, chest; single view)
• 74019 (Radiologic examination, abdomen; 2 views)

However, a combination code exists in the CPT^® code set that covers multiple abdomen X-ray views and a one-view chest X-ray:

• 74022 (Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect, decubitus), and a single view chest)

“While 74019 does encompass the two-view abdomen X-rays, 74022 would be the most appropriate, most specific code to use for this scenario because it encompasses both the single-view chest X-ray and two-view abdomen X-rays,” says Taylor Berrena, COC, CPC, CPB, CRC, CEMC, CFPC,coder II at MD Anderson Cancer Center at Cooper in Yorktown, Virginia. Since a single code option exists that encompasses both X-ray studies, reporting the procedures with two separate codes is the incorrect option.

In fact, when you verify the chest X-ray code options in the 2023 CPT^® code set, you’ll find that 71045 does encompass the single-view chest X-ray, but a parenthetical note listed after 71048 (… 4 or more views) provides key instruction on handling abdomen and chest X-ray studies.

The note indicates that you’ll use 74022 “[f]or complete acute abdomen series that includes [two] or more views of the abdomen [eg, supine, erect, decubitus], and a single view chest.”

Understand What Separates 74022 from 74019

Both 74019 and 74022 include two abdominal X-ray views, so how do the two codes differ? In addition to the single-view chest X-ray, another factor separates 74022 from 74019. That crucial information in 74022’s descriptor is the phrase “complete acute abdomen series.”

An acute abdomen series is ordered in response to sudden abdominal pain that may be caused by an infection, inflammation, severe trauma, or other conditions. Providers perform an acute abdomen series to visualize and evaluate several body structures, including:

• Esophagus
• Duodenum
• Stomach
• Liver
• Spleen
• Large and small intestines
• Diaphragm

In the scenario listed above, the provider performed a complete acute abdomen series to check for any traumatic injuries the patient may have sustained during the motor vehicle accident.

Review the Documentation for Crucial Information

The provider’s documentation needs to include crucial information that will help you assign the correct code for the services provided. Code 74022’s descriptor indicates that the provider must capture at least two views of the patient’s abdomen. The views offered as examples are different from your standard AP, posteroanterior (PA), and oblique views, but the radiologist uses the views to visualize the patient’s abdominal structures.