Monday, July 19, 2010

Procedure code 71020, 71010 on CMS 1500

Radiology procedures on the CMS-1500 claim form

Procedure CODE 71010 - Radiologic examination, chest; single view, frontal - Average fee amount $20 - $26

 Procedure COD E 71020 (Radiologic examination chest, two views, frontal and lateral;   Average fee amount $20 - $26

Billing Tips:

X-Rays - When single view and double view chest X-Rays are billed together (71010 and 71020), only the double view X-Ray is allowed.

Critical Care Services - Codes 36000, 36410, 36415, 36591, 36600, 43752, 43753, 71010, 71015, 71020, 92953, 93561, 93562, 94002, 94003, 94004, 94660, 94662, 94760, 94761, 94762, and 99090 are considered incidental to 99291 and 99292(Critical Care Services).

Critical Care Services - Codes 36000, 36410, 36415, 36591, 36600, 43752, 43753, 71010, 71015, 71020, 92953, 93561, 93562, 94002, 94003, 94004, 94660, 94662, 94760, 94761, 94762, and 99090 are considered incidental to 99291 and 99292(Critical Care Services).


Electrocardiogram 71020

Chest X-ray, PA and lateral

*The level of service represents only an example. The level reported should be determined by the documented history, exam and/or medical decision-making.

Note that the work associated with performing the history, examination and medical decision making for the problem-oriented E/M service will likely overlap those performed as part of the comprehensive preventive service to a certain extent. Therefore, the E/M code reported for the problem-oriented service should be based on the additional work performed by the physician to evaluate that problem. An insignificant or trivial problem or abnormality that does not require performance of these key components should not be reported separately from the preventive medicine service.




X-Rays - When single view and double view chest X-Rays are billed together (71010 and 71020), only the double view X-Ray is allowed. When the entire spine, survey study is billed (72082) with cervical spine films (72040), thoracic spine films (72070) or lumbosacral spine films (72100) only the entire spine, survey study code is allowed. When a single view X-Ray code is billed with a multiple view X-Ray code, only the multiple view X-Ray code is allowed (e.g., 72020 with 72040, 72070, or 72100). Only one professional and one technical component are allowable per X-Ray.

Procedure Panels

A Procedure panel is a set of Procedure linked to a short cut code. Panels of commonly used Procedure combinations are set up to speed data entry. For example, a Chem 7 would take 42 keystrokes to enter if the Procedure for each lab is entered individually. But all of these can be linked to a code such as C7 which, with the Enter key, is only 3 keystrokes. This is a significant speed and efficiency improvement.

Another example of the use of Procedure Panels is where users may typically enter one code such as an order for a procedure in Chart, but it has to be billed to a payor as multiple other codes. Medicare, for example, often requires a procedure to be billed using the technical and professional components with the –TC and -26 modifiers. A panel can be set up to include two custom Procedure which are then mapped to default modifiers in the Medicare fee schedule. For example, if billing a 71020 X-Ray, you can build 71020*T and 71020*P custom (starred) Procedure codes, add those to your fee schedule for Medicare with default modifiers of TC and 26 respectively, and then map a panel to the original 71020 which will pull the components automatically.


Error Examples 

Billed Procedure 71020. Missing the physician order or documentation of intent of ordering the billed chest x-ray. Received an order sheet without a signature. Requested order and received an altered document with a signature added. Therefore, there is no order. Also missing medical necessity

How to avoid this type of error

All diagnostic services require a signed physician order and documentation supporting medical necessity to be payable by Medicare. A signature cannot be added to a previously unsigned physician order upon request for review. In addition, an unsigned requisition is not acceptable documentation of physician intent to order laboratory services.

When completing claims, do not enter the decimal points in ICD-9-CM codes or dollar amounts.  If requested information does not fit neatly in the Reserved for Local Use field (Box 19) of the claim, type it on an 8½ x 11-inch sheet of paper and attach it to the claim.

Modifier 59 usage on Procedure CODE 71020

>Procedure Code 32551 – Tube thoracostomy, includes connection to drainage system (eg, water seal), when performed, open

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

Modifier 59 may be reported if, later in the day following the insertion of a chest tube, the patient develops a high fever and a chest x-ray is performed to rule out pneumonia. Procedure code 71020 should not be reported and modifier 59 should not be used for a chest x-ray that is performed following insertion of a chest tube in order to verify correct placement of the tube.

Modifier 59 is used appropriately for a diagnostic procedure which occurs subsequent to a completed therapeutic procedure only when the diagnostic procedure is not a common, expected, or necessary follow-up to the therapeutic procedure.


Chest X-ray

This is an example only.  Please adapt to your billing situation.

In this example, Procedure-4 code 71020 (radiologic examination, chest; two views, frontal and lateral) is billed with modifier ZS (indicating both professional and technical components were provided) in the Procedures, Services or Supplies field (Box 24D).

In the Date(s) of Service field (Box 24A), the date of the office visit, June 7, 2007 is entered on claim line 1 as 060707.  Enter Place of Service code 11 (office) in Box 24B.

Enter the referring provider name in the Name of Referring Provider or Other Source field (Box 17) and the referring provider’s NPI in

Box 17B.  Enter the rendering provider’s information in Service Facility Location Information field (Box 32) and the NPI in Box 32A.

Enter the usual and customary charges in the Charges field
(Box 24F).  Enter a 1 in the Days or Units field (Box 24G) for code 71020.


Example : Column 1 Code / Column 2 Code – 32551/71020

Procedure Code 32551 – Tube thoracostomy, includes connection to drainage system (eg, water seal), when performed, open

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

Modifier 59 may be reported if, later in the day following the insertion of a chest tube, the patient develops a high fever and a chest x-ray is performed to rule out pneumonia. Procedure code 71020 should not be reported and modifier 59 should not be used for a chest x-ray that is performed following insertion of a chest tube in order to verify correct placement of the
tube.

Modifier 59 is used appropriately for a diagnostic procedure which occurs subsequent to a completed therapeutic procedure only when the diagnostic procedure is not a common, expected, or necessary follow-up to the therapeutic procedure.


Procedure CODE 71010

Helpful Hints for Billing

* Always use Modifiers. For example for the Procedure-4 code (chest-x-ray) 71010 use either modifier -26 or –TC to denote either the professional code or technical code.

* Pharmacy Providers may use Point of Sale

* Use website to view status of bill or authorization for services rendered: http//:owcp.dol.acs-inc.com

* Outpatient Hospital services can be billed on the UB 92 form with appropriate Revenue Center Codes requiring Procedure/HCPCS codes.

* All bills must contain the DEEOIC’s 9-digit case number of your patient or client and your 9-digit provider number.

* Laboratory, x-ray, physical therapy, and clinical tests such as EKGs, etc. must be identified with the correct Procedure code.

* Facility charges for ambulatory surgical center/outpatient surgery billing must be billed using the surgical Procedure code. Modifier SG should be used.

* When billing for inpatient services, your Medicare number must be included.




When performed on the day a physician bills for critical care, the following services are included in the critical care service, and should not be reported separately:

• the interpretation of cardiac output measurements (Procedure 93561, 93562)

• chest x-rays, professional component (Procedure 71010, 71015, 71020)

• blood draw for specimen (Procedure 36415)

• blood gases, and information data stored in computers (e.g., ECGs, blood pressures, hematologic data (Procedure 99090))

• gastric intubation (Procedure 43752, 91105)

• pulse oximetry (Procedure 94760, 94761, 94762)

• temporary transcutaneous pacing (Procedure 92953)

• ventilator management (Procedure 94002 – 94004, 94660, 94662)

• vascular access procedures (Procedure 36000, 36410, 36415, 36591, 36600)

No other procedure codes are bundled into the critical care services. Therefore, other medically necessary procedure codes may be billed separately.


Reporting example: For a single frontal chest x-ray, the claim for Procedure code 71010 (Radiologic examination, chest; single view, frontal) would be submitted in one of the following two ways:

1. either as a global service, if the professional and technical components are submitted together:

* Global – 71010


2. or as individual claims for the professional and technical components, when submitted separately:

* Professional only – 71010-26  and

* Technical only – 71010-TC Professional bilateral radiology services are reported as two lines with LT and RT modifiers.


The following example indicates the appropriate use of modifier 59 when two procedures codes that are not ordinarily performed together on the same day by the same provider, are reported.

• A single view chest x-ray (71010) is part of the more comprehensive radiologic exam described by 74022 (radiologic examination abdomen; complete acute abdomen series, including supine, erect, and/or decubitus views, single view chest). If these two procedures are reported together, 71010 will be denied separate reimbursement.

• When a single view chest x-ray is performed on the same day but at a different time and patient encounter, appending modifier 59 to Procedure 71010 is warranted to signify that a separate and distinct service was performed. (Modifier 59 should follow modifier 26, if services are done in a facility setting.) Modifier 59 will override the procedure unbundling edit and 71010 will be eligible for separate reimbursement.

1 comment:

  1. Hi. You can find a blank Fillable CMS 1500 Insurance Claim Form here.
    http://goo.gl/QZYITd

    Please feel free to use it. You can fill out the form, save it, fax it, and email it.

    ReplyDelete

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