Radiology Coding Alert

Plus, improve your view type understanding.

As a radiology coder, you’re sure to see a fair share of spinal X-ray encounters in your workflow, and it’s important to familiarize yourself with the guidelines, anatomy, and common documentation to ensure your codes are reported correctly.

Follow along as we break down the spinal X-ray code information.

Pay Attention to Spine Sections When Choosing X-ray Codes

The CPT^® code set includes several diagnostic imaging codes for the spine. The Radiology chapter’s Spine and Pelvis code section features X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) codes, and you’ll select the applicable code based on the imaging equipment, spinal section, and the number of views captured.

For X-ray imaging examinations, you’ll turn to the CPT^® code set Index and look for X-ray > Spine. Under Spine, you’ll find codes related to different areas of the spine that a radiologist will examine.

From the top to the bottom, there are four sections that make up the spine — cervical, thoracic, lumbar, and sacrum and coccyx.

• Cervical spine: The seven vertebrae located at the top of the spine, called the cervical spine, form the neck.
• Thoracic spine: The thoracic spine consists of the next 12 vertebrae.
• Lumbar spine: The lower back, also known as the lumbar spine, is made up of five vertebrae.
• Sacrum/coccyx: Nine vertebrae are combined into solid bone to make up the sacrum and coccyx (tailbone).

You’ll assign 72020 (Radiologic examination, spine, single view, specify level) when the radiology report lists only one view of a certain level.

If the radiologist images the patient’s cervical spine, you’ll assign one of the following codes:

• 72040 (Radiologic examination, spine, cervical; 2 or 3 views)
• 72050 (… 4 or 5 views)
• 72052 (… 6 or more views)

You’ll assign one of the following codes when the provider captures images of the patient’s thoracic spine:

• 72070 (Radiologic examination, spine; thoracic, 2 views)
• 72072 (… thoracic, 3 views)
• 72074 (… thoracic, minimum of 4 views)

A radiologist may need to examine overlapping sections of the spine, such as the thoracic and lumbar sections or the lumbar and sacrum sections. In those instances, you’ll look for codes related to these unique areas. If the physician images the spine where the thoracic and lumbar sections meet, known as thoracolumbar, you’ll assign 72080 (…thoracolumbar junction, minimum of 2 views).

However, when the physician captures X-rays of the patient’s lumbar spine and sacrum, also known as the lumbosacral spine, you’ll assign one of the following codes:

• 72100 (Radiologic examination, spine, lumbosacral; 2 or 3 views)
• 72110 (… minimum of 4 views)
• 72114 (… complete, including bending views, minimum of 6 views)
• 72120 (… bending views only, 2 or 3 views)

Lastly, X-ray examinations of the entire spine for a scoliosis evaluation are coded using:

• 72081 (Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); one view)
• 72082 (… 2 or 3 views)
• 72083 (… 4 or 5 views)
• 72084 (… minimum of 6 views)

Codes 72081-72084 also apply to thoracolumbar and lumbosacral imaging exams. You’ll notice the descriptors also include examinations of the “skull, cervical, and sacral spine if performed.” This means that you can assign the codes even if the radiologist also captures images of those anatomical structures.

Identify Additional Spinal X-ray Views

Depending on the injury or potential disease, radiologists might need additional views beyond anteroposterior (AP), posteroanterior (PA), lateral, and oblique to make a definitive diagnosis. “Additional views can include odontoid, extension/flexion, swimmers, and scoliosis films,” says Andrea Beabes, BS, RRT, CPC, coding manager/ senior billing specialist of University Radiology Associates, LLP in Syracuse, New York.

• Odontoid views: Providers use odontoid views to image the cervical spine.
• Lateral extension/flexion views: “This helps to identify degenerative cervical spondylolisthesis that may go otherwise undiagnosed in the patient,” Beabes explains.
• Lateral swimmers view: Radiologists use this view to evaluate the patient’s lower cervical spine as well as the cervicothoracic junction.
• Extension/flexion views: Providers use these views with the lumbar or thoracic spine to help diagnose spinal instability.
• Scoliosis films: Radiologists can view the entire thoracolumbar spine with erect AP or PA views to check for scoliosis.

Each CPT^® code includes a specific number of views that must be captured, recorded, and documented in the report. By combining the terms listed above with your knowledge of AP, PA, lateral, and oblique views, you can accurately count the number of views to assign the correct procedure code.

Understand These Tips to Improve Your Coding

Coders who are new to radiology may experience some growing pains while acclimating to the specialty. One way to familiarize yourself with radiology coding is to immerse yourself in the field. This can be done by examining charts and labeled pictures of the spine and keeping them on hand to reference when you’re coding. At the same time, compiling a cheat sheet of radiology-specific medical terminology, such as different X-ray views, will be beneficial while you find your radiology coding footing.

You can also consider boots-on-the-ground experience. “If possible, shadow an orthopedic physician or radiology technician for education of procedures,” Beabes says. This experience can be very helpful for visual learners who gain more knowledge from seeing how a procedure is performed.