Radiology Coding Alert

Question: If a patient has a pneumothorax from the CT-guided (computer tomography) biopsy, can we use CPT 71010 (single view chest) over and over in the same day following the pneumothorax? Some patients will have a single view chest four or five times following the CT biopsy. And can we use it again if a chest tube is inserted?

Vermont Subscriber

Answer: If a patient has a pneumothorax following a CT biopsy of the lung (512.1), multiple chest x-rays may be necessary to monitor the status of the patients lungs. These services would be billable because there would be medical necessity to substantiate the multiple chest x-rays.

One of the most important things to remember when billing multiple chest x-rays on the same day is to make sure the diagnosis is appropriate for each x-ray performed and pneumothorax clearly falls into that category. The physician must monitor the status of the patients lungs, and any pertinent changes must be attended to immediately.

The follow-up chest x-rays may be billed using a -76 modifier (repeat procedure by same physician) if the same physician is interpreting the x-ray, or a -77 modifier (repeat procedure by another physician) if a different physician is interpreting the follow-up x-ray.

A chest x-ray following a chest tube placement would be billed in addition to the chest x-rays to check the pneumothorax status. You may want to assign a secondary diagnosis code (e.g., V71.8, observation for other specified suspected condition) and would bill the service code with a -59 modifier (distinct procedural service) to indicate that it was a distinct service.

Payers may have their own limits set up for the number or frequency of follow-up chest x-rays for pneumothorax. Some payers also may try to bundle these x-rays. If this happens, resubmit the claim with copies of each of the chest ray reports. It would be beneficial to have the time each x-ray was taken documented in the report.

Source for this reader question was Stacey Hall, RHIT, CPC, CCS-P, director of corporate coding for Medical Management Professionals Inc., a national billing and management firm for hospital-based practices, in Chattanooga, Tenn.