Thursday, September 15, 2016

CPT CODES - 71010, 71020 - 71035 - Chest X RAY

PROCEDURE CODE and Description

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;  Fee amount $27 - $35

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; - Fee amount $35,- $45

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

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


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


CHEST XRAY CODES:

Chest x-ray codes 71010-71035 will be no more used in 2018 ane we would report these services based on the number of views next year.

** 71045 (Radiologic examination, chest ; single view).
** 71046 (Radiologic examination, chest ; 2 views).
** 71047 (Radiologic examination, chest ; 3 views).
** 71048 (Radiologic examination, chest ; 4 or more views).

Codes 74000-74020 will be deleted and replaced by the following codes:

** 74018 (Radiologic examination, abdomen; 1 view).
** 74019 (Radiologic examination, abdomen; 2 views).
** 74021 ( Radiologic examination, abdomen; 3 or more views).


Ultrasound exams have been revised. Revised descriptors instruct us to report a complete service when the provider examines the joint space and the surrounding soft tissues. We should report a limited service when the exam involves a joint space or surrounding soft tissues such as tendons or nerves:

** 76881 Ultrasound, extremity, nonvascular, complete joint (ie, joint space and peri-articular soft tissue structures) real-time with image documentation; complete.

** 76882 Ultrasound, limited, anatomic specific joint or other nonvascular extremity structure(s) (eg, joint space, peri-articular tendon[s], muscle[s], nerve[s], other soft tissue structure[s], or soft tissue mass[es]), real-time with image documentation.


Indications and Limitations of Coverage and/or Medical Necessity

Note: Providers should seek information related to National Coverage Determinations (NCD) and other Centers for Medicare & Medicaid Services (CMS) instructions in CMS Manuals. This LCD only pertains to the contractor's discretionary coverage related to this service.

Radiologic examination of the chest (chest X-ray) facilitates the detection, diagnosis, staging and management of pathophysiologic processes involving thoracic, cardiovascular, pulmonary and mediastinal structures, contiguous coverings and the bony thorax. These examinations are covered by Medicare when medically necessary and appropriate for evaluation and management of a specific symptom, sign, disease or injury.

Chest X-rays are utilized in a variety of clinical states.

Generally accepted medical diagnoses are enunciated as Covered ICD-10 Codes (Covered Codes). Noridian Administrative Services will utilize these Covered Codes, and medical consultation, to assess medical necessity and appropriate utilization.

Routine, screening, pre operative or periodic examinations in the absence of symptoms, signs or disease states as represented by Covered ICD-10-CM Codes will not be reimbursed [Section 1862(a)(1)(A) of the Social Security Act].

Following a stable chronic condition, generally one examination in a twelve-month period will be considered appropriate. In acute or subacute conditions or when new symptoms or findings are documented, more frequent examinations will be considered for reimbursement and are subject to medical necessity review.

Submission with a Covered Code does not, a priori, equate with reimbursement. Clinical setting and examination frequency will also be assessed.


Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

12 - Hospital Inpatient (Medicare Part B only)
13 - Hospital Outpatient
22 - Skilled Nursing - Inpatient (Medicare Part B only)
23 - Skilled Nursing - Outpatient
85 - Critical Access Hospital


Helpful Hints for Billing



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 code 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

** 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 code/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.

*These procedures require pre-certification; call 1-877-PRE-AUTH


Physician Type Procedure Codes Description

Primary Care Physicians: 71010-71030 Chest imaging
Cardiologists 71010-71030 Chest imaging
Pediatricians 71010-71030 Chest imaging
Pulmonologists 71010-71030 Chest Imaging


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


Radiology - Chest and rib X-ray

What is changing?

When Procedure code 71010 and Procedure code 71100 are billed for the same day, the codes will be recoded to the comprehensive Procedure code or Procedure code 71101.
** Procedure code 71010 is defined as “radiologic examination, chest; single view, frontal.”
** Procedure code 71100 is defined as ”radiologic examination, ribs, unilateral; two views.”
** Procedure code 71101 is defined as “radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of three views.”

Why is Humana implementing this change?

Procedure code 71010 is for a chest X-ray, and code 71100 is for rib views. If both views are being performed, the appropriate code to bill is code 71101, which is for the rib and chest views, per AMA’s Procedure code description.


ST2 Assay

Soluble ST2 (sST2) (suppression of tumorigenicity 2) is a protein in blood thought to act as a decoy receptor of interleukin-33. Other terms are “growth stimulation expressed gene 2” and “interleukin 1 receptor like-1.” Either ST2 or sST2 may be used to indicate the soluable form. ST2 has been found to be induced in cardiac myocytes that have been mechanically overloaded. Onset or worsening of heart failure and scars from myocardial infarction that reduce stretching of the heart are examples of conditions in which ST2 is elevated. (Ciccone et al., 2013) Clinical use as a prognostic indicator for individuals with acute dyspnea and acute or chronic heart failure has been proposed and studied. Shah et al. (2009) studied 134 of 599 dyspneic patients enrolled in the “Pro-BNP Investigation of Dyspnea in the Emergency Department” study. The 134 patients in this study had echocardiography (ECHO) requested by the treating physician. ST2 levels were drawn on admission and correlated with the ECHO findings four years later. Independent risk factors for death were also reviewed. The study population was elderly (69 + 14 years), overweight (BMI 28 + 7 kg/m2), evenly divided by gender with a history of hypertension (61%), coronary artery disease (31%), heart failure (37%), obstructive pulmonary disease (27%), and preserved renal function. Acute heart failure was considered the etiology of dyspnea in 66%. The ST2 concentration was significantly correlated with high level ventricular (LV) end-systolic area, LV volume, and end-systolic dimension but not with left-atrial dimension or volume. Patients with higher ST2 levels, stratified by quartile, had incrementally higher risks of death at four (4) years. Patients who had died, compared to survivors were older, more likely to have a history of heart failure, have used loop diuretics or an angiotensin-converting enzyme inhibitor on presentation, and more likely to have evidence of volume overload on admission chest x-ray, worse renal function, lower hemoglobin concentration, and higher concentrations of NT-proBNP as well as ST2.

Usage with Modifier 59

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 CPT 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.

No Modifier: when reporting global billing.

EXAMPLE: 71010 (Radiologic examination, chest; single view, frontal)
 Global: 71010 (Done in ER)
Reading: 71010-26 (Reading done by ER physician)
 Technical: 71010-TC


Modifier 76– appended to the CPT when repeated by the same physician on the same day.

Modifier 77– appended to the CPT when repeated by another physician on the same day.

Please note: Medicare considers all physicians in the same group practice with the same specialty to be the same physician

EXAMPLE: 71010-26 (Dr X)
 71010-26-76 (Dr X) *** submit medical documentation
 71010-26-77 (Dr Y) *** submit medical documentation



ICD-10 Codes that Support Medical Necessity


ICD-10 CODE DESCRIPTION

A02.1 Salmonella sepsis
A02.22 Salmonella pneumonia
A06.4 Amebic liver abscess
A06.5 Amebic lung abscess
A07.8 Other specified protozoal intestinal diseases
A15.0 Tuberculosis of lung
A15.4 Tuberculosis of intrathoracic lymph nodes
A15.5 Tuberculosis of larynx, trachea and bronchus
A15.6 Tuberculous pleurisy
A15.7 Primary respiratory tuberculosis
A15.8 Other respiratory tuberculosis
A17.0 Tuberculous meningitis
A17.1 Meningeal tuberculoma
A17.81 Tuberculoma of brain and spinal cord
A17.82 Tuberculous meningoencephalitis
A17.83 Tuberculous neuritis
A17.89 Other tuberculosis of nervous system
A17.9 Tuberculosis of nervous system, unspecified
A18.01 Tuberculosis of spine
A18.02 Tuberculous arthritis of other joints
A18.03 Tuberculosis of other bones
A18.09 Other musculoskeletal tuberculosis
A18.10 Tuberculosis of genitourinary system, unspecified
A18.11 Tuberculosis of kidney and ureter
A18.12 Tuberculosis of bladder
A18.13 Tuberculosis of other urinary organs
A18.14 Tuberculosis of prostate
A18.15 Tuberculosis of other male genital organs
A18.16 Tuberculosis of cervix
A18.17 Tuberculous female pelvic inflammatory disease
A18.18 Tuberculosis of other female genital organs
A18.2 Tuberculous peripheral lymphadenopathy
A18.31 Tuberculous peritonitis
A18.32 Tuberculous enteritis
A18.39 Retroperitoneal tuberculosis
A18.4 Tuberculosis of skin and subcutaneous tissue
A18.50 Tuberculosis of eye, unspecified
A18.51 Tuberculous episcleritis
A18.52 Tuberculous keratitis
A18.53 Tuberculous chorioretinitis
A18.54 Tuberculous iridocyclitis
A18.59 Other tuberculosis of eye
A18.6 Tuberculosis of (inner) (middle) ear
A18.7 Tuberculosis of adrenal glands
A18.81 Tuberculosis of thyroid gland
A18.82 Tuberculosis of other endocrine glands
A18.83 Tuberculosis of digestive tract organs, not elsewhere classified
A18.84 Tuberculosis of heart
A18.85 Tuberculosis of spleen
A18.89 Tuberculosis of other sites
A19.0 Acute miliary tuberculosis of a single specified site
A19.1 Acute miliary tuberculosis of multiple sites
A19.2 Acute miliary tuberculosis, unspecified
A19.8 Other miliary tuberculosis
A19.9 Miliary tuberculosis, unspecified
A20.0 Bubonic plague
A20.1 Cellulocutaneous plague
A20.2 Pneumonic plague
A20.3 Plague meningitis
A20.7 Septicemic plague
A20.8 Other forms of plague
A20.9 Plague, unspecified
A21.0 Ulceroglandular tularemia
A21.1 Oculoglandular tularemia
A21.2 Pulmonary tularemia
A21.3 Gastrointestinal tularemia
A21.7 Generalized tularemia
A21.8 Other forms of tularemia
A21.9 Tularemia, unspecified
A22.0 Cutaneous anthrax
A22.1 Pulmonary anthrax
A22.2 Gastrointestinal anthrax
A22.7 Anthrax sepsis
A22.8 Other forms of anthrax
A22.9 Anthrax, unspecified
A23.0 Brucellosis due to Brucella melitensis
A23.1 Brucellosis due to Brucella abortus
A23.2 Brucellosis due to Brucella suis
A23.3 Brucellosis due to Brucella canis
A23.8 Other brucellosis
A23.9 Brucellosis, unspecified
A24.0 Glanders
A24.1 Acute and fulminating melioidosis
A24.2 Subacute and chronic melioidosis
A24.3 Other melioidosis
A24.9 Melioidosis, unspecified
A25.0 Spirillosis
A25.1 Streptobacillosis
A25.9 Rat-bite fever, unspecified
A26.0 Cutaneous erysipeloid
A26.7 Erysipelothrix sepsis
A26.8 Other forms of erysipeloid
A26.9 Erysipeloid, unspecified
A27.0 Leptospirosis icterohemorrhagica
A28.0 Pasteurellosis
A28.2 Extraintestinal yersiniosis
A28.8 Other specified zoonotic bacterial diseases, not elsewhere classified
A28.9 Zoonotic bacterial disease, unspecified
A30.0 Indeterminate leprosy
A30.1 Tuberculoid leprosy

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