CPT® 2018: Retrain Your Brain To Ensure Spot-On Coding For Chest and Abdomen X-Rays

Chest X-rays are common tests (understatement!), and providers frequently order and perform abdomen X-rays, too. If you’re one of the many medical coders who needs to know how to report those X-rays, there are seven new codes in CPT® 2018 that you won’t want to miss. Here’s the scoop.

Streamline Chest X-Ray Options with Focus on Views

In 2017, your CPT® code search for chest X-rays leads you to 71010-71035. Among those 2017 CPT® codes, you’ll find code options that differ based on number of views and also types of views. For instance, note the inclusion of frontal and lateral in the descriptor for two-view code 71020 (Radiologic examination, chest, 2 views, frontal and lateral).

CPT® 2018 deletes 71010-71035 and replaces those old familiar codes with a simpler set of four codes. The new code descriptors keep the focus on number of views:

  • 71045 (Radiologic examination, chest; single view)
  • 71046 (… 2 views)
  • 71047 (… 3 views)
  • 71048 (… 4 or more views).

Tip: With families of codes like these, it’s helpful if your online CPT® code lookup resource lets you view the codes in a range so you can compare your options, just as you would in a printed manual. Also consider how easy it is to navigate from one code-specific page to another. You’ll want to be able to get from one code to the next without a lot of effort to simplify comparison of your code choices.

Keep CAD Coding in Mind for Guideline Updates

When medical procedure codes change, you have to check the guidelines related to those codes, too. For the chest X-ray codes, CPT® 2018 guidelines center on proper reporting of computer-aided detection (CAD).

Don’t: For CAD performed remotely from the primary interpretation, you should NOT report the new chest X-ray codes 71045-71048 together with 0175T (Computer-aided detection (CAD) (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation and report, with or without digitization of film radiographic images, chest radiograph(s), performed remote from primary interpretation).

Code 0175T is a standalone code that is appropriate when chest X-ray CAD is performed at a different time, at a different location, or by another physician than the original chest X-ray.

Do: For concurrent CAD performed in conjunction with 71045-71048, use +0174T (Computer-aided detection (CAD) (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation and report, with or without digitization of film radiographic images, chest radiograph(s), performed concurrent with primary interpretation (List separately in addition to code for primary procedure)).

In other words, CAD code +0174T is an add-on code, and appropriate primary chest X-ray codes include 71045-71048.

Focus on Number of Views for Abdomen, Too

Abdomen X-ray codes will also see a change in CPT® 2018. CPT® 2018 will delete current codes 74000, 74010, and 74020, which specify types of views. For example, note the views required in 74010 (Radiologic examination, abdomen; anteroposterior and additional oblique and cone views).

In 2018, your CPT® procedure code lookup will include the following codes which, like the chest X-ray codes, are based on number of views:

  • 74018 (Radiologic examination, abdomen; 1 view)
  • 74019 (… 2 views)
  • 74021 (… 3 or more views).

Important: CPT® 2018 does NOT delete 74022 (Radiologic examination, abdomen; complete acute abdomen series, including supine, erect, and/or decubitus views, single view chest). You’ll still have that code available in 2018 to represent an acute abdomen series with a single view of the chest.

What Can You Expect for Reimbursement?

The proposed 2018 Medicare Physician Fee Schedule (MPFS) shows the expected work RVUs for the new codes are in line with the work RVUs assigned to the equivalent 2017 codes.

For example, 2017 code 71030 (Radiologic examination, chest, complete, minimum of 4 views) is assigned .31 work RVUs in the 2017 MPFS. New chest X-ray code 71048, for four or more views, is also assigned .31 work RVUs in the proposed 2018 MPFS.

Similarly, 2017 code 74020 (Radiologic examination, abdomen; complete, including decubitus and/or erect views) is assigned 0.27 work RVUs in the 2017 MPFS. And 74021 (three or more views) is assigned 0.27 work RVUs in the proposed 2018 MPFS.

Below are the work RVUs proposed for each code.

Chest X-Ray Code Work RVUs in Proposed 2018 MPFS

  • 71045, 0.18
  • 71046, 0.22
  • 71047, 0.27
  • 71048, 0.31

Abdomen X-Ray Code Work RVUs in Proposed 2018 MPFS

  • 74018, 0.18
  • 74019, 0.23
  • 74021, 0.27
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