Radiology Coding Alert

Question: How should I code for a two-view chest (71020) and unilateral ribs (71100) performed on the same date for the same patient? Insurance denies the claim, refusing to pay them separately, but according to the CCI edits, I don't need a modifier to report these codes together.

Answer: You are coding the provided services correctly, so you have to decide whether you want to spend time and energy on an appeal for the reimbursement a rib x-ray will bring (roughly $30 global).

For a two-view chest x-ray and unilateral rib x-ray performed on the same patient on the same date, you should report both 71020 (Radiologic examination, chest, two views, frontal and lateral) and 71100 (Radiologic examination, ribs, unilateral; two views).

Don't miss: If the provider instead performed a single-view (PA) chest and rib x-ray, you should look for the single code that describes both services rather than reporting them separately, such as 71101 (Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of three views).

Payers should reimburse both 71020 and 71100 because they involve separate films taken to evaluate different anatomic structures. The Correct Coding Initiative (CCI) did bundle these services at one point but deleted the edit retroactive to its 1996 introduction.

Options: You can find out whether your payer will cover the exams if you append modifier 59 (Distinct procedural service) to the rib exam. If not, you'll have to decide whether you want to appeal. If so, be sure to include the information that CCI deleted this edit.

-- The answers for You Be the Coder and Reader Questions were reviewed by Jackie Miller, RHIA, CPC, senior consultant with Coding Strategies Inc. in Powder Springs, Ga.