Radiology Coding Alert

You may be an old hand at submitting X-ray claims, but nuances can trip up even the most seasoned of coders. Check out these real-life scenarios provided by radiology coders like you to hone your understanding of the coding rules and guidelines.

Look For Bending or Extension Views

Scenario 1: A radiologist regularly performs spot, lateral, obliques, and AP views that you will code using 72110 (Radiologic examination, spine, lumbosacral; minimum of 4 views). Should you report 72100 (… 2 or 3 views), as well, if your radiologist also performs flexion and extension views — in addition to other views?

Solution: No. CPT^® offers a more applicable code, so you should not report 72100 with 72110 for this scenario. “Instead of billing the 72100 with 72110, due to the X-ray exams being billed based upon the number of views and the bending views, it would be best to report 72114 (… complete, including bending views, minimum of 6 views),” says Sandy Giangreco Brown, BS, RHIT, CCS, CCS-P, CHC, COC, CPC, CPC-I, COBGC, PCS, Director of Coding and Revenue Integrity for CLA in Loveland, Colorado.

Helpful: To stay in line, make sure you check National Correct Coding Initiative (NCCI) edits. You could face an unbundling issue if you try to report 72110 and 72100 together.

Understanding 72110: You will use code 72110 if the radiologist performs a lumbosacral spine exam that includes a minimum of four views. The views include an AP, a lateral, and the obliques — LPO (left posterior oblique) and RPO (right posterior oblique).

Extra detail: To perform a scan of the obliques, the technician will lay the patient on their side and bring the leg on top forward, which will cause the torso to twist. You can also roll the patient to a 45-degree angle to capture a similar view.

There may also be documentation of a lateral spot image. A lateral spot image is a small spot of film of the lumbosacral junction (fifth view). All four views and the spot film are covered by code 72110.

Understanding 72114: An exam that includes all images performed of the lumbar spine will fall under code 72114, which the descriptor states complete and bending views. For this exam, bending views include films taken of the spine when the patient is standing up and bending to the sides (right and left). The exam also includes flexion views (when the patient looks down and brings their chin down toward their chest) and extension views (when the patient looks up and lifts their head toward the ceiling).

Key distinction: If you have images that contain only the bending views, you should use CPT^® code 72120 (Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views). The key element in code 72120 is only 2 or 3 bending views.

Code 72100 is also for 2 or 3 views, but the descriptor for 72100 does not specify the type of views. Therefore, if you have 2 or 3 bending views, 72120 is the correct code to use, not 72100.

Bottom line: You will code 72114 if your report has bending views or flexion/extension views in addition to the regular views.

Stay Up to Date on Official ICD-10-CM Guidelines

Scenario 2: A radiologist reads a respiratory preoperative chest X-ray for a patient with chronic obstructive pulmonary disease (COPD) who is preparing to have a knee replacement procedure. Which diagnosis code(s) should be used in the report to indicate the medical need for the chest X-ray?

Solution: According to the ICD-10-CM official guidelines, “For patients receiving preoperative evaluations only, sequence first a code from subcategory Z01.81, Encounter for pre-procedural examinations, to describe the pre-op consultations. Assign a code for the condition to describe the reason for the surgery as an additional diagnosis. Code also any findings related to the pre-op evaluation.”

For example: In this situation, you should use code Z01.811 (Encounter for preprocedural respiratory examination) for the preoperative respiratory exam and code the COPD with J44.9 (Chronic obstructive pulmonary disease, unspecified) if your radiologist reads a pre-knee replacement two-view chest x-ray ordered for a patient with COPD.

You will link Z01.811 to CPT^® code 71046 (Radiologic examination, chest; 2 views) for a preoperative chest x-ray as the primary diagnosis. You will also report the appropriate code to show the medical necessity for the surgery, such as M17.9 (Osteoarthritis of knee, unspecified), Brown says.

Good news: Typically, Medicare and other payers will cover medically needed preoperative chest X-rays.

Bonus tip: You may encounter other preoperative X-ray ICD-10-CM codes, such as:

• Z01.810 (Encounter for preprocedural cardiovascular examination)
• Z01.818 (Encounter for other preprocedural examination).