Medicare Compliance & Reimbursement

Supercharge your skills by knowing which guidelines to keep handy. Medical coders must be masters of all modalities, but even coding for the long-established x-ray can require you to handle new situations and apply complicated coding rules. Here's the how-to on three real-life x-ray scenarios provided by coders like you. Scenario 1: Your physicians routinely perform AP, lateral, obliques, and spot views that you code using 72110 (Radiologic examination, spine, lumbosacral; minimum of four views). If one doctor also performs flexion and extension views -- in addition to the other views -- for a particular patient, should you report 72100 (... two or three views), too? Solution: No. You should not report 72100 in addition to 72110 for this situation because CPT offers a more appropriate code. If you perform AP, lateral, obliques, spot, and the flexion/extension bending views, you should report 72114 (... complete, including bending views) for all the images, says Rick D. Gladish, RCC, CPC, RMC, director of operations for Professional Accounts Management and president-elect of the Tupelo, MS, AAPC chapter. Helpful: Checking Correct Coding Initiative (CCI) edits will help keep you in line. If you try to report 72110 and 72100 together, you'll face an unbundling issue, Gladish says. 72110 explained: If the spine exam includes a minimum of four views, "and the views include an AP, lateral, and the obliques -- LPO (left posterior oblique) and RPO (right posterior oblique) -- then you code a 72110," Gladish notes. What to watch for: "The obliques usually are done by laying the patient on their side and bringing the leg on top forward, which causes the torso to twist, or also by rolling the patient to a 45 degree angle," Gladish says. You also may see documentation of "a lateral spot, which is a small spot film of the lumbosacral junction (fifth view)," Gladish says. Code 72110 covers all four views and the spot film, he says. 72114 explained: The descriptor for 72114 states, "complete including bending views" and this exam would include any and all images performed of the lumbar spine during an exam. Bending views include films taken of the spine with the patient standing up and bending to the sides (left and right), flexion views (when you bring the chin down toward the chest), and extension (when you lift your head toward the ceiling)," Gladish says. Important distinction: CPT also offers 72120 (Radiologic examination, spine, lumbosacral, bending views only, minimum of four views), which you should use "when the only images that are done are the bending views," Gladish says. Key to 72120 is a minimum of four views. Code 72110 is also for a minimum of four views, but like 72100, the descriptor [...]