Radiology Coding Alert

CPT®:

Expand Your Knowledge of Chest X-ray View Types

Published on Mon Aug 22, 2022

Understand that rib X-ray codes specify laterality.

Chest X-rays allow physicians to visualize several structures within the patient’s body to make an informed evaluation. When you’re coding diagnostic chest and rib X-ray tests, knowing the different types of views helps you determine the correct code to assign.

Assess your chest X-ray coding skills with the following scenarios.

Identify the Typical Chest X-ray Views

With diagnostic X-rays, the number of views is what you need to assign the correct code, rather than the number of captured images. “Providers orient the patient or X-ray equipment to capture different X-ray views. Typical chest X-ray views include anteroposterior (AP), posteroanterior (PA), lateral, and oblique, but providers may also use lesser-known views to examine specific conditions,” says Lauren E. Braico, CPC, CEDC, medical coder and AAPC local chapter officer in Syracuse, New York.

Additional chest X-ray views include:

Decubitus: Captured while the patient is lying down, usually on their side. This view helps providers distinguish pleural effusions (fluid buildup between the tissues lining the lungs and chest) from consolidation (like in pneumonia), as well as loculated effusions (small chambers of fluid in the pleural cavity) from free fluid in the patient’s pleural space (space between the lungs and the chest wall).
Lordotic: Helps visualize abnormalities and allows the provider to view the apex (top) of the lung.
Expiratory: Ideal for diagnosing pneumothorax, also known as a collapsed lung. This occurs when air leaks out into the pleural space causing the lung to collapse.

Scenario: A patient is referred to a radiology practice for chest X-rays after presenting to their primary care physician (PCP) with a persistent dry cough and shortness of breath. The radiologist captures AP, PA, lateral, and right and left oblique views of the patient’s chest and interprets the results.

In the scenario above, the radiologist captured five different views — AP, PA, lateral, and right and left oblique — of the patient’s chest and the surrounding structures. You’ll use this information to determine your code selection.

When you open the AMA’s CPT^®index and look under X-ray > Chest, you’re presented with the range of codes. Next, you’ll turn to the Radiology section in the CPT^®code set to select and verify your code. You’ll find the following chest X-ray codes:

71045 (Radiologic examination, chest; single view)
71046 (… 2 views)
71047 (… 3 views)
71048 (… 4 or more views)

Since the radiologist captured five views and interpreted the results, you’ll assign 71048 for the service.

Use Laterality to Determine the Correct Rib X-ray Code

Bruises to or fractures of the ribs can make day-to-day life painful for patients. These bones enclose and help protect the heart and lungs, and, if damaged, the rib pain can be excruciating when the patient inhales or coughs.

When coding X-rays of the ribs, laterality, number of views, and targeted structures are the keys to determining which code to assign. Look up X-ray > Ribs in the AMA CPT^®code set index, where you’ll discover the code range. When you turn to the Radiology section of the code set, you’ll have the following codes to choose from:

71100 (Radiologic examination, ribs, unilateral; 2 views)
71101 (… including posteroanterior chest, minimum of 3 views)
71110 (Radiologic examination, ribs, bilateral; 3 views)
71111 (… including posteroanterior chest, minimum of 4 views)

“There is a differentiation in CPT^®codes for rib X-rays that are performed unilaterally and bilaterally,” says Chelsea Kemp, BS, RHIT, CCS, COC, CPC, CDEO, CPMA, CRC, CCC, CEDC, CGIC, AAPC Approved Instructor, outpatient coding educator/auditor at Yale New Haven Health in New Haven, Connecticut. Codes 71100-71101 cover unilateral X-ray views of the ribs. This means the radiologist captured images on only one side of the patient’s body, whereas 71110-71111 specify bilateral services in which the radiologist captures images on both sides of the patient’s body.

At the same time, regardless of whether you’re assigning unilateral or bilateral rib X-ray codes, you’ll need to pay attention to the types of views captured. Each rib X-ray CPT^®code covers a different number of views, but the descriptors for 71101 and 71111 specifically call out a PA chest view.

Scenario: A patient’s PCP referred the patient for X-rays of the right ribs to evaluate for a fracture. The radiologist captured AP, lateral, and PA chest views of the right ribs. After interpreting the results, the radiologist documented their findings as a right rib contusion.

In this scenario, you’ll assign 71101 since the radiologist captured three views, including a PA chest view, of one side of the patient’s body. You may also need to append modifier RT (Right side) to the CPT^®code to indicate laterality, but you should review your individual payer’s preferences to ensure proper reporting.

Are Modifiers Necessary for Rib X-rays?

When a radiologist captures rib X-rays on both sides of the patient’s body, you’ll assign an appropriate code from 71110-71111, depending on the number of and types of views captured. What if the radiologist captures only one or two views of bilateral ribs? “If less than three views were taken, modifier 52 (Reduced services) should be appended to 71110,” Kemp says.