Radiology Coding Alert

Question: We performed three views of the ribs (unilateral) with no chest involved. Which code should we report? The descriptor for CPT 71100 only specifies two views, so we'd like to report 71101.

Kansas Subscriber

Answer: Although you performed three views, you should still report 71100 (Radiologic examination, ribs, unilateral; two views).
 
Because you didn't take any films of the patient's chest, you cannot report 71101 (... including posteroanterior chest, minimum of three views).
 
When CPT first established the rib x-ray codes, most radiologists performed only two views per side as standard practice. Now, however, radiologists usually take three or four views per side.
 
Radiology training programs and many department protocols would consider a request for a unilateral rib exam to mean three views of the ribs only, including an anteroposterior (AP) or posteroanterior (PA) view, depending on where the patient's injury is located, in addition to two oblique views.
 
Because the above scenario describes the minimum two views of the ribs but no chest radiograph, you should report 71100. Although some coders consider a single AP view of the ribs a "chest" view, you usually can't view the entire chest on the film because it only shows one side of the thorax.
 
And, the exposure techniques differ for chest and rib x-rays because technologists often use different types of film for these two sites.
 
Remember, however, to check the documentation and confirm the exact description of the three views that the radiology technologist performed. In many settings, the radiologist or technologist will document that the third rib view was indeed a single view chest, albeit with different exposure factors than a practitioner might use to detect primary pulmonary pathology.
 
Because 71101's descriptor does not specify radiographic technique, if your technologist performed a chest view along with the rib views, you should report
code 71101.

 - The answers for You Be the Coder and Reader Questions were reviewed by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Dallas, Ga.; and Gary S. Dorfman, MD, FACR, FSIR.