Coding tips for CPT code 71045, 71046, 71047 and 71048

Coding tips for KUB & CPT code 71045, 71046, 71047 and 71048

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X-ray procedures has been coded very frequently in radiology coding. The chest and abdomen X-ray CPT codes are very common to code every year.  CPT code 71045, 71046, 71047 and 71048 are used for coding Chest X-ray. While  CPT code 74018, 74019 and 74021 are used for coding abdomen X-ray (KUB). Radiology coders need to use specific codes for  coding chest and abdomen x-ray cpt codes . We will also checkout some of the  deleted codes in the past later on this chapter. 

Description of CPT code 71045, 71046, 71047 and 71048

71045 (Radiologic examination, chest; single view).
71046 (…; 2 views).
71047 (…; 3 views).

71048 (…; 4 or more views).

74018 (Radiologic examination, abdomen; 1 view).

74019 (…; 2 views).

74021 (…; 3 or more views).

These CPT codes are totally based on the number of views. As per number of views, medical coders can directly select the CPT codes of chest x-ray and abdomen x-ray.
Coding tips for CPT code 71045, 71046, 71047 and 71048
 

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Procedure description for CPT code 71045, 71046, 71047 and 71048

Chest radiographs or X-rays actually provide images of the heart, lungs, bronchi, major blood vessels (aorta, vena cava, pulmonary vessels), and bones, (sternum, ribs, clavicle, scapula, spine). The most common views for CPT code 71045, 71046, 71047 and 71048 are frontal (also referred to as anteroposterior or AP), posteroanterior (PA), and lateral. Now, these views are taken from different position.
In Frontal view, the patient is positioned facing the x-ray machine
PA view is obtained with the patient’s back toward the x-ray machine. 
For a lateral view, the patient is positioned with side of the chest toward the machine.
An apical lordotic image provides better visualization of the apical (top) regions of the lungs. 
Oblique views are obtained to evaluate a pulmonary or mediastinal mass or opacity or to provide additional images of the heart and great vessels. There are four positions used for oblique views including right and left anterior oblique, and right and left posterior oblique.
Anterior oblique views are obtained with the patient standing and the chest rotated 45 degrees. The arm closest to the x-ray cassette is flexed with the hand resting on the hip. The opposite arm is raised as high as possible. The part of the chest farthest away from the x-ray cassette is the area being studied.
Posterior oblique views are typically obtained only when the patient is too ill to stand or lay prone for anterior oblique views. A lateral decubitus view is obtained with the patient lying on the side; the patient’s head rests on one arm, and the other arm is raised over the head with the elbow bent.
All the Images are recorded on hard copy film or stored electronically as digital images. The physician reviews the images, notes any abnormalities, and provides a written interpretation of the findings.
Modifier FX is used for X-rays taken using film. FX is a new modifier added to identify imaging services that are X-rays taken using film. From January 1st, 2017 hospitals are required to use this modifier for imaging services that are X-rays Utilizing film.
                   

When not to report CPT code 71045, 71046, 71047 and 71048

In most of the percutaneous chest procedures like Central venous catheter placement, thoracentesis, chest tube insertion(CPT code 32550), 32551, 32554, 32555)etc. after the exam done, a chest radiological exam is performed. In short, a chest x-ray is done to confirm the location and proper positioning of the tube or catheter. Also, chest x-ray helps in knowing the status of the exam performed. 

Hence, in such radiological exam are integral part of the main procedures and chest radiological examination (e.g., CPT codes 71045, 71046) shall not be reported separately.

Modifier used with Radiology CPT codes

The most common modifier used with radiology cpt codes are 26 (Professional component) and TC (technical component)  modifier. Guidelines used for professional, technical, and global components of a procedure. These components are as follows:
1. Professional: describes the services of the physician, including the supervision of the taking of the x-ray film and the interpretation with report of the x-ray films.
2. Technical: describes the services of the technologist, as well as the use of the equipment, film, and other supplies.
3. Global: describes the combination of the professional and technical components (1 and 2).

For example, if a patient undergoes a radiology procedure in a clinic that owns its own equipment, employs its own technologist(s), and also employs the radiologist who supervises, interprets, and reports on the radiologic results, the global procedure is reported. But if the radiologist is reading and interpreting films that were taken at another facility, only the professional component would be reported for physician services.

“Third-party payment is generally 40% for the professional component, 60% for the technical component, and 100% for the global service.”

Deleted CPT codes for Chest X-ray in 2018

Old codes for chest and abdomen x-rays have been used for long time. There is a long list of chest X-ray CPT codes  deleted. Below are the list of deleted CPT codes. 

71010 – Radiologic examination, chest; single view, frontal – Fee amount $20 – $26

71015 – Radiologic examination, chest; stereo, frontal

71020 – Radiologic examination, chest, 2 views, frontal and lateral

71021 – Radiologic examination, chest, 2 views, frontal and lateral; with apical lordotic procedure

71022 – Radiologic examination, chest, 2 views, frontal and lateral; with oblique projections

71023 – Radiologic examination, chest, 2 views, frontal and lateral; with fluoroscopy

71030 – Radiologic examination, chest, complete, minimum of 4 views; 

71034 – Radiologic examination, chest, complete, minimum of 4 views; with fluoroscopy

71035 – Radiologic examination, chest, special views (eg, lateral decubitus, Bucky studies)

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Deleted CPT code for  Abdomen X-ray

The old abdomen x-ray codes for one view (KUB) and two view are going to get deleted in 2018. 

74000 CPT code for one view of abdomen

74020 Supine and erect studies of abdomen

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