Radiology Coding Alert

Question: Our radiologist obtained PA and lateral views of the chest on X-ray for the patient. There was a questionable area in the right lung, so the patient was asked for a repeat X-ray.  PA and shallow oblique views with nipple markers were obtained on the same date. How can we bill for these procedures? Please suggest the right codes.

North Carolina Subscriber

Answer: The best choice seems to be code 71022 (Radiologic examination, chest, 2 views, frontal and lateral; with oblique projections) as it clearly describes 2 views with oblique projections. You will need to check with your payer if your payer allows only the highest or total number of views to be reported for a single date.

Below is an excerpt from the CCI manual, Chapter IX, Section C.1: 

“If radiographs have to be repeated in the course of a radiographic encounter due to substandard quality, only one unit of service for the code can be reported. If the radiologist elects to obtain additional views after reviewing initial films in order to render an interpretation, the Medicare policy on the ordering of diagnostic tests must be followed. The CPT code describing the total service should be reported, even if the patient was released from the radiology suite and had to return for additional services.”

You can read more at http://cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html.

In the scenario mentioned by you, it is appropriate to code for individual encounters. You can hence report code 71020 (Radiologic examination, chest, 2 views, frontal and lateral) for the initial X-rays taken for the patient and code 71022 for the PA and shallow oblique view. You may append modifier 59 (Distinct procedural service) to 71022. You also append modifier 52 (Reduced services) to 71022 to specify that PA and shallow oblique views were obtained on X-ray without the lateral view. This is because the descriptor for 71022 specifies that the code applies to both frontal and lateral views and any additional oblique views.

Note: Your radiologist may obtain X-rays in more than one view. The views include the Anteroposterior (AP): front to back; apical: chest including lung apex to minimize the rib image overlapping a lung lesion; bucky: film placed in a device that eliminates secondary radiation; decubitus (DEC): lying on side; LAO (left anterior oblique): left front; LPO (left posterior oblique): left rear; oblique: angled view; odontoid: open-mouth cervical spine view to identify joint space C1; posteroanterior (PA): back to front; RAO (right anterior oblique): right front; RPO (right posterior oblique): right rear; stereo: two views of a structure, one at 90 degrees to the film and second with tube angled 12 degrees to 15 degrees toward the head; swimmers: thoracic x-ray with one or both arms over head.