Count the Views — Not the Images — to Bill X-Rays Correctly
Question: A patient presented to urgent care with a fever of 101.2 degrees Fahrenheit (F), five days of an acute productive cough, and crackles at the base of the right lung. The patient does not have a history of chronic lung disease and is a nonsmoker. The on-site radiologist captured posteroanterior (PA) and lateral chest X-rays, but they repeated the PA view because the patient moved during the initial exposure. The technologist captured three images, so our charge system defaulted to 71047. Is that correct, or should we change the procedure code to 71046? Indiana Subscriber Answer: You should definitely change the procedure code to 71046 (Radiologic examination, chest; 2 views). X-ray codes are distinguished by the number of views captured, not the total number of images. If the radiologist needed to repeat a projection because of movement, patient positioning, or exposure error, then the retake is a technical issue, and it doesn’t count as an additional view. You could only consider 71047 (… 3 views) if the radiologist obtained a third distinct projection, such as an oblique or apical lordotic view, and documented the view in the record. As a radiology coder, it’s important to make sure that each projection is named in the record, because otherwise you cannot select an appropriate multiview code. If the record is missing this information, query the provider to amend the documentation. Mike Shaughnessy, BA, CPC, Production Editor, AAPC
