Coding tips for KUB & CPT code 71045, 71046, 71047 and 71048

X-ray procedures has been coded very frequently in radiology coding. The chest and abdomen X-ray CPT codes are very common to code every year.  CPT code 710457104671047 and 71048 are used for coding Chest X-ray. While  CPT code 74018, 74019 and 74021 are used for coding abdomen X-ray (KUB). So, radiology coders need to get update with coding guidelines for coding chest and abdomen x-ray cpt codes in 2020. We will also checkout some of the  deleted codes in the past later on this chapter. 

Description of CPT code 71045, 71046, 71047 and 71048

71045 (Radiologic examination, chest; single view).
71046 (…; 2 views).
71047 (…; 3 views).

71048 (…; 4 or more views).

74018 (Radiologic examination, abdomen; 1 view).

74019 (…; 2 views).

74021 (…; 3 or more views).

Thes3 CPT codes are totally based on the number of views. As per number of views, medical coders can directly select the new CPT codes of chest x-ray and abdomen x-ray.
Coding tips for CPT code 71045, 71046, 71047 and 71048
 

Read also: Coding guide for anesthesia CPT codes

                   Superb coding tips for modifier 57

                  When to Use of Modifier 96 and 97 

Procedure description for CPT code 71045, 71046, 71047 and 71048

Chest radiographs or X-rays actually provide images of the heart, lungs, bronchi, major blood vessels (aorta, vena cava, pulmonary vessels), and bones, (sternum, ribs, clavicle, scapula, spine). The most common views for CPT code 71045, 71046, 71047 and 71048 are frontal (also referred to as anteroposterior or AP), posteroanterior (PA), and lateral. Now, these views are taken from different position.
In Frontal view, the patient is positioned facing the x-ray machine
PA view is obtained with the patient’s back toward the x-ray machine. 
For a lateral view, the patient is positioned with side of the chest toward the machine.
An apical lordotic image provides better visualization of the apical (top) regions of the lungs. 
Oblique views are obtained to evaluate a pulmonary or mediastinal mass or opacity or to provide additional images of the heart and great vessels. There are four positions used for oblique views including right and left anterior oblique, and right and left posterior oblique.
Anterior oblique views are obtained with the patient standing and the chest rotated 45 degrees. The arm closest to the x-ray cassette is flexed with the hand resting on the hip. The opposite arm is raised as high as possible. The part of the chest farthest away from the x-ray cassette is the area being studied.
Posterior oblique views are typically obtained only when the patient is too ill to stand or lay prone for anterior oblique views. A lateral decubitus view is obtained with the patient lying on the side; the patient’s head rests on one arm, and the other arm is raised over the head with the elbow bent.
All the Images are recorded on hard copy film or stored electronically as digital images. The physician reviews the images, notes any abnormalities, and provides a written interpretation of the findings.
Modifier FX is used for X-rays taken using film. FX is a new modifier added to identify imaging services that are X-rays taken using film. From January 1st, 2017 hospitals are required to use this modifier for imaging services that are X-rays Utilizing film.
                   

When not to report CPT code 71045, 71046, 71047 and 71048

               
In most of the percutaneous chest procedures like Central venous catheter placement, thoracentesis, chest tube insertion(CPT code 32550), 32551, 32554, 32555)etc. after the exam done, a chest radiological exam is performed. In short, a chest x-ray is done to confirm the location and proper positioning of the tube or catheter. Also, chest x-ray helps in knowing the status of the exam performed. 

Hence, in such radiological exam are integral part of the main procedures and chest radiological examination (e.g., CPT codes 71045, 71046) shall not be reported separately.

Modifier used with Radiology CPT codes

The most common modifier used with radiology cpt codes are 26 (Professional component) and TC (technical component)  modifier. Guidelines used for professional, technical, and global components of a procedure. These components are as follows:
1. Professional: describes the services of the physician, including the supervision of the taking of the x-ray film and the interpretation with report of the x-ray films.
2. Technical: describes the services of the technologist, as well as the use of the equipment, film, and other supplies.
3. Global: describes the combination of the professional and technical components (1 and 2).

For example, if a patient undergoes a radiology procedure in a clinic that owns its own equipment, employs its own technologist(s), and also employs the radiologist who supervises, interprets, and reports on the radiologic results, the global procedure is reported. But if the radiologist is reading and interpreting films that were taken at another facility, only the professional component would be reported for physician services.

“Third-party payment is generally 40% for the professional component, 60% for the technical component, and 100% for the global service.”

Deleted CPT codes for Chest X-ray in 2018

Old codes for chest and abdomen x-rays have been used for long time. There is a long list of chest X-ray CPT codes  deleted. Below are the list of deleted CPT codes. 

71010 – Radiologic examination, chest; single view, frontal – Fee amount $20 – $26

71015 – Radiologic examination, chest; stereo, frontal

71020 – Radiologic examination, chest, 2 views, frontal and lateral

71021 – Radiologic examination, chest, 2 views, frontal and lateral; with apical lordotic procedure

71022 – Radiologic examination, chest, 2 views, frontal and lateral; with oblique projections

71023 – Radiologic examination, chest, 2 views, frontal and lateral; with fluoroscopy

71030 – Radiologic examination, chest, complete, minimum of 4 views; 

71034 – Radiologic examination, chest, complete, minimum of 4 views; with fluoroscopy

71035 – Radiologic examination, chest, special views (eg, lateral decubitus, Bucky studies)

Read also: Awesome tips to become a Professional Certified Coder

                    Coding tips for Bone marrow biopsy and aspiration CPT codes

Deleted CPT code for  Abdomen X-ray

The old abdomen x-ray codes for one view (KUB) and two view are going to get deleted in 2018. 

74000 CPT code for one view of abdomen

74020 Supine and erect studies of abdomen

17 Thoughts to “Coding tips for KUB & CPT code 71045, 71046, 71047 and 71048”

  1. Roger Robinson

    Is there difference in coding for a ‘frontal & lateral’ Chest exam done on a machine that only produces a single PA view and a Lateral view (2 total ‘images’), and a ‘frontal & lateral’ Chest exam done on another machine that, through dual-energy software in the x-ray machine, automatically creates additional Lung and Bone window ‘views’ from the initial PA exposure (for a total of three PA ‘images’) Only one PA view ‘exposure’ is taken on the second machine, but it produces three ‘images’! Also, what is the difference between the terms ‘View’ and ‘Image’? I would think the term ‘view’ refers to positioning (i.e. AP,PA, Oblique, Lateral, etc.) and the term ‘image’ refers to the ‘number of images’ created and sent for interpretation. The CPT Code Book uses the term ‘View’ in the code description and therefore I think for a ‘frontal & lateral’ Chest exam we should be using the current 71020 code (and soon 71046 code) for either situation. To ‘upcode’ to 71047 or 71048, just for exams performed on the machine with the additional dual-energy ‘image’ capability I would think constitutes fraud since only two ‘exposures’ were taken to complete the Chest exams done on both machines, right?? Your thoughts??

    1. Do not get confuse…the documentation should be clear and only number of views should be counted to coded the correct CPT code…images are not considered equivalent to views…PA, lateral, frontal etc. should be mention to count the number of views for chest X-ray and should be coded accordingly…if you get any report which document images and not views then we should query the physician…!!

  2. […] Read also: New CPT code changes for Abdomen and Chest X-ray in 2018 […]

  3. […] Read also: Coding tips for Chest and abdomen X-ray new CPT codes in 2018 […]

  4. […] codes in October every year. Hence, it is very important for medical coders to remain updated with new changed CPT and ICD 10 codes. The updated codes especially CPT codes sometimes will be easy to learn compared […]

  5. […] codes. There are other procedure codes for HIDA scan (CPT 78226 & 78227), bone scan, mammogram, chest x-ray, abdominal ultrasound, MRI exam etc. which are performed for specific diagnosis. Also, along with […]

  6. […] year their has been new CPT codes added in Radiology Facility. In 2018, we saw new CPT codes for chest and abdomen X-ray procedures. This was a very big change in radiology facility, because chest and abdomen X-ray […]

  7. […] codes include any imaging to document the final catheter positioning, so the billing of a separate chest x-ray (71045, 71046, 71047, or 71048) will not be allowed on the same date as the PICC insertion or replacement.  When the final […]

  8. […] the latest new CPT codes for Chest and abdomen X-ray in 2018 for medical […]

  9. […] placement, which is V58.81 (Z45.2) for central line placement (36555-36571) and for chest x ray (71045 or 71046) on same day. Now, here if we code chest X ray along with central line placement CPT Code, chest x […]

  10. […] Read also: When to use Chest X ray CPT codes in Radiology […]

  11. […] Read also: New CPT code changes in Chest and Abdomen X-ray […]

  12. […] Read also: Coding Guide CPT code for abdomen and Chest X-ray for medical coders  […]

  13. […] 99 = Concept does not apply Read also: Coding Tips for KUB and chest xray CPT codes RVU and Fees for CPT code […]

Leave a Reply