Wiki Xray cpt codes

[mbodily5]

Hi Everybody,


I just started helping with medical billing at a chiropractic clinic and they do xrays in-house. I have not billed xray cpt codes before. And specifically I am working on past claims and claims denials. I have come across 2 patients that had 3 xray cpt codes billed in one visit: 72040-cervical, 72070-thoracic, 72100- lumbar. On both patients it denied saying the cervical & thoracic is inclusive to the 72100 and only paid for code. Actually one patient they changed the cpt code to 72084 comprehensive. First question- is it normal or legal for insurance companies to change your cpt code. And should the chiropractor be billing with the comprehensive code, 72084 and not the 3?

Any help is appreciated!!

 

[LaurenBrooke]

Chap 9 Radiology Services NCCI Policy Manual for CMS (revision date 1/1/2022):

17. CPT codes 72081-72084 describe radiologic examination of the entire spine, the codes differing based on the number of views. The other codes in the CPT code range 72020-72120 describe radiologic examination of specific regions of the spine differing based on the region of the spine and the number of views. If a physician performs a procedure described by CPT codes 72081-72084 and at the same patient encounter performs a procedure described by one or more other codes in the CPT code range 72020-72120, the physician shall sum the total number of views and report the appropriate code in the CPT code range 72081-72084. The physician shall not report a code from the CPT code range 72081-72084 plus another code in the CPT code range 72020-72120 for services performed at the same patient encounter.

Hope this helps!

 

[nazcoder]

Chap 9 Radiology Services NCCI Policy Manual for CMS (revision date 1/1/2022):

17. CPT codes 72081-72084 describe radiologic examination of the entire spine, the codes differing based on the number of views. The other codes in the CPT code range 72020-72120 describe radiologic examination of specific regions of the spine differing based on the region of the spine and the number of views. If a physician performs a procedure described by CPT codes 72081-72084 and at the same patient encounter performs a procedure described by one or more other codes in the CPT code range 72020-72120, the physician shall sum the total number of views and report the appropriate code in the CPT code range 72081-72084. The physician shall not report a code from the CPT code range 72081-72084 plus another code in the CPT code range 72020-72120 for services performed at the same patient encounter.

Hope this helps!

helpful reply! how may I find NCCI edits for entire range of radiology codes? The link from CMS does not include all radiology codes. Thank you!