Taking a Closer Look at the New X-Ray Codes

2018 brought a complete revision of the abdomen and chest x-ray codes with all but one of the previous abdomen and chest x-ray codes being deleted and replaced. We will take a closer look at the new codes and guidelines.

Chest X-Rays

For 2018, the number of chest x-rays codes was reduced from 9 to only 4. The table below shows the deleted codes for 2018, which included the number and types of views and use of fluoroscopy.

Code Description
71010 Radiologic examination chest; single view, frontal
71015 …stereo, frontal
71020 Radiologic examination, chest, 2 views, frontal and lateral;
71021 …with apical lordotic procedure
71022 …with oblique projections
71023 …with fluoroscop
71030 Radiologic examination, chest, complete, minimum of 4 views;
71034 …with fluoroscopy
71034 Radiologic examination, chest, special views (eg, lateral decubitus, Bucky studies)

Four new codes were established to report chest x-rays: 71045, 71046, 71047, and 71048. See the table below for the code descriptions.

Code Description
71045 Radiologic examination, chest; single view
71046 …2 views
71047 …3 views
71048 …4 or more views

Codes 71045-71048 are defined in terms of the number of views. To select the appropriate code, simple count the number of views. Code selection does not change for special views, such as lateral decubitus or expiration views. For example, if an exam consists of posteroanterior (PA), lateral decubitus, and lateral upright views, it would be reported with code 71047 for chest x-ray, 3 views.

When counting views, each oblique view that is performed should be counted separately. This includes right anterior oblique (RAO), left anterior oblique (LAO), right posterior oblique (RPO), and left posterior oblique (LPO). Additionally, inspiration and expiration views are each counted separately as are left lateral decubitus and right lateral decubitus views.

Because there are no longer combination codes for chest x-ray with fluoroscopy, each should be separately reported. The fluoroscopy can be reported with codes 76000 or 76001.

Chest x-ray with CAD is still reported with Category III codes +0174T and 0175T. When the same provider interprets the chest x-ray and the CAD, report the CAD with add-on code +0174T. Report code 0175T when CAD interpretation is performed as a stand-alone service without chest x-ray interpretation.

Tomosynthesis is a type of thin slice x-ray examination. Tomosynthesis exams of the chest are reported with code 76100.

Remember that the chest x-ray codes should not be used for x-rays of the ribs, sternum, and sternoclavicular joints since these areas have their own x-ray codes.

Abdomen X-Rays

For 2018, three of the four abdomen x-ray codes were deleted and three new codes were added. Code 74022 (Radiologic examination, abdomen; complete acute abdomen series, including supine, erect and/or decubitus views, single view chest) is still a valid code.

The table on the next page shows the deleted codes, which are defined in terms of the number and types of views.

Code Description
74000 Radiologic examination, abdomen; single anteroposterior view
74010 …anteroposterior and additional oblique and cone views
74020 …complete, including decubitus and/or erect views

The three new codes for abdomen x-rays are simply defined by the number of views rather than the type of views. See the table below for code descriptions.

Code Description
74018 Radiologic examination, abdomen; 1 view
74019 …2 views
74021 …3 or more views

A KUB (“kidneys, ureters, and bladder”) is a single AP view and is reported with code 74018. However, a KUB may be performed as a scout exam before a gastrointestinal study such as a barium enema, in which case it cannot be reported unless the procedure is cancelled.

Code 70422 is sometimes referred to as an obstruction series or acute abdomen series. Code 74022 requires and includes all of the following:

  • Supine AP view of the abdomen (KUB or flat plate)
  • Upright or erect PA and/or decubitus view of the abdomen
  • PA upright view of the chest

If the exam includes 2 views of the chest rather than 1, the chest and abdomen should be separately reported. The 2 view chest x-ray would be reported with code 71046, and the abdomen x-ray would be reported with code 74019 or 74021 depending on the number of views.

While there was a complete overhaul of the 2018 abdomen and chest x-ray codes, it certainly seems to have been for the better. Coding abdomen and chest x-rays is more straightforward than ever before.

- Article by Coding Strategies® Staff