Radiology Coding Alert

Question: I have a report that lists the radiologist captured PA and AP chest X-rays and an AP chest X-ray. The report indicates the radiologist performed the two-view chest X-rays first, and then the single-view chest X-ray after the ordering physician removed the patient’s chest tube.

I’m completely stumped if I should report two separate chest X-ray codes or a three-view chest X-ray code. How should I report this encounter?

Alaska Subscriber

Answer: You’ll report two separate chest X-ray codes for the report you described. Start by reporting 71046 (Radiologic examination, chest; 2 views) since the radiologist captured two-view chest X-rays first consisting of posteroanterior (PA) and anteroposterior (AP) views. Next, you’ll assign 71045 (… single view) to report the single-view chest X-ray captured after the removal of the patient’s chest tube. You’ll also append 71045 with modifier 59 (Distinct procedural service) to indicate the second X-ray code was necessary but separate from the original imaging service.

Wanting to report a three-view chest X-ray code, such as 71047 (… 3 views), is understandable but ultimately incorrect. If the radiologist had only captured three views before or after the chest tube removal, then you could assign a three-view chest X-ray code. However, the radiologist performed two separate procedures, so you can’t sum the views to report a code with the total number of views.

NCCI edits: The National Correct Coding Initiative (NCCI) edits bundle 71045 into 71046 because a single-view X-ray would be included in the two-view X-ray. Code 71045 features a modifier indicator of “1,” which means the code can be unbundled from 71046 when appropriate. In this case, the single-view chest X-ray was a second, separately reportable service that was medically necessary, which means you may override the edit by appending modifier 59 to 71045.

In summary, you’ll assign the following procedure codes for the encounter:

• 71046
• 71045-59