Learn the Basics Surrounding Rib X-ray Services
Anatomy, views, laterality , and modifiers are important when coning radiological exams.
By Sivaraj Ramesh, CPC, CEMC, CCS
Ribs are long, curved bones that are slightly twisted on a long axis. The rib cage consists of 12 pairs of ribs, 12 thoracic vertebra, the sternum, and xiphoid process. It encloses and protects the heart and lungs.
Many Ribs and Joints Make Up the Rib Cage
There are typical and atypical ribs. The basic parts of a typical rib are the head, neck, and body. The head of the rib has the shape of a blunt arrow (except for the first and last three ribs, where it is rounded). It has two facets: The superior facet articulates with the intervertebral disc superior to the vertebra, and the inferior tubercle articulates with the corresponding vertebral body. The head is continuous with the slightly narrower neck, which extends to a tubercle situated on the posterior/inferior aspect of the rib. The body of the rib is flat and curved. It’s angled slightly forward, forming the angle of the rib. A groove (the costal groove) is present at the inferior border of the rib for neurovascular supply to the thorax, and protects the nerves and blood vessels from damage.
Ribs 3-9 are typical ribs. Ribs 1, 2, 10, 11, and 12 are atypical ribs, which vary from the general structure described above. For example, rib 1 is short and wide. The head has only one facet that articulates with corresponding vertebrae.
There are three types of ribs:
True ribs are also called vertebro sternal ribs. The first seven ribs are called true ribs. Each rib attaches to the sternum directly through the costal cartilage.
False ribs are also called vertebro chondral ribs. Ribs 8-10 are false ribs. The costal cartilage of these ribs articulates with the costal cartilage of the superior rib.
Floating ribs are also called vertebral ribs. Ribs 11 and 12 are called floating ribs because they have no anterior attachment to the sternum.
There are several joints associated with the ribs:
The costotransverse joint is a synovial joint formed by articulation of costal tubercle of rib with costal facet on the transverse process of the corresponding vertebrae. There are 10 pairs of costotransverse joints articulating vertebra T1 to T10, corresponding to the ribs of the same number.
The costovertebral joint is also a synovial joint. The head of the ribs has two facets (i.e., superior costal vertebral facet and inferior costal vertebral facet).
The superior costal vertebral facet articulates with the intervertebral disc superior to the vertebra, while the inferior costal vertebral facet articulates with the corresponding vertebral body.
CPT® Codes Are Based on Structure, Laterality, and Views
CPT® codes describe radiologic exam of the ribs based on the structure(s) targeted, laterality, and the number of views.
71100 Radiologic examination, ribs, unilateral; 2 views
X-rays are taken unilaterally (either left or right) of the problem side of the ribs with two views: anteroposterior position (AP) or posterior-anterior (PA) views.
71101 Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views
X-rays are taken unilaterally (either left or right) of the problem side of the ribs (e.g., AP and oblique views of the left ribs) and frontal view of the chest.
71110 Radiologic examination, ribs, bilateral; 3 views
X-rays are taken bilaterally of the ribs for three views of the ribcage.
71111 Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views
X-rays are taken bilaterally of the ribcage, including the posterior ribs and PA chest. A minimum of four views are taken.
71120 Radiologic examination; sternum, minimum of 2 views
X-rays are taken of the sternum, with a minimum of two views: AP and lateral.
71130 Radiologic examination; sternoclavicular joint or joints, minimum of 3 views
X-rays are taken of the sternoclavicular joint or joints a minimum of three views (with and without weights).
Modifiers Describe Two Distinct Portions of Service
The X-ray services described by a single CPT® code are comprised of two distinct portions: a professional component and a technical component.
The professional component includes the physician’s supervision, interpretation, and a written report. To claim only the professional portion of a service, CPT® Appendix A (Modifiers) instructs you to append modifier 26 Professional component to the appropriate CPT® code.
The technical component of a service includes the provision of all equipment, supplies, personnel, and costs related to the performance of the exam. To claim only the technical portion of a service, append modifier TC Technical component to the appropriate CPT® code. Fees for the technical component are reimbursed to the facility or practice responsible for these costs.
A global service includes both the professional and technical components of a single service. When reporting a global service, no modifiers are necessary to receive payment for both components of the service. If the provider who interprets the film also owns the equipment, the global procedure code is submitted at full fee.
Put Your Rib Knowledge to Work
Example: A two-view, unilateral rib X-ray is performed in a freestanding radiology clinic, and a physician who is not employed by the facility interprets the films.
Code it: The clinic appends modifier TC to the appropriate chest X-ray code (e.g., 71100-TC) to account for the cost of supplies and staff. The physician who interprets the X-ray submits a claim for the same code with modifier 26 appended (i.e., 71100-26). The fee for the service will be split, with approximately 60 percent of payment allotted for the technical component and 40 percent for the professional component.
Sivaraj Ramesh, CPC, CEMC, CCS, is an assistant manager for Global Healthcare Billing Partners Pvt. Ltd. He has a professional degree in physical therapy and a master’s degree in psychology. He has more than 10 years of experience in medical coding, with multispecialty expertise in radiology, evaluation and management, and surgery.