Dec 5th, 2022 - ALRheum 1
Billing multiple Spine xray
Can anyone help shed light on billing for spine x-rays? For example: one of my providers performed an x-ray of the lumbar (72100) and the neck (72040), typically I would just void the lesser charge x-ray and bill that out, but I feel like that's a lot of money when we are doing the x-ray for two separate areas of the spine. I have another that performed 72052(6>views), 72110(4> views), 72170, 72070. I have read the CMS guidelines however, from what I see they don't typically refer to what I'm looking for, I was told we could not bill for an LVA x-ray anymore (72081/72082-we also have some with pelvic views as well)I would appreciate any help here!Thanks!
Dec 5th, 2022 - ChrisW 256 1
re: Billing multiple Spine xray
The NCCI edits manual can help with this. I am not sure why you would not bill for 72081-72082 if you view the entire spine. Codes 72081-72082 are done to assess scoliosis, such as the type of scoliosis, and the location and degree of curvature. Code selection depends on how many views were taken, for example, 72081 is reported for a single view. "Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (e.g., scoliosis evaluation); one view".
Your questions and other radiology questions can quickly be answered by using the NCCI Edits Validator. The NCCI Edit manual can be found on this page as well.If you have a subscription to Find-A-Code, check out the NCCI Codes Validator. If you don't have a subscription, you can try it out with a Free trial.
NCCI Edits Manual
Take a look at the NCCI edits manual Chapter IX Radiology Service CPT codes 70000-7999917. CPT codes 72081-72084 describe a 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 the 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.
Two Different Body parts
You are missing out on revenue if you are not billing 72100 and 72040. Both codes should both be reported as they are different body parts, lumbosacral and cervical.
72100 X-RAY EXAM L-S SPINE 2/3 VWS (spine, lumbosacral)
72040 X-RAY EXAM NECK SPINE 2-3 VW (spine, cervical)
These are all different body parts and should be reported if done. 72052 X-RAY EXAM NECK SPINE 6/>VWS (spine, cervical)
72110 X-RAY EXAM L-2 SPINE 4/>VWS (spine, lumbosacral)
72170 X-RAY EXAM OF PELVIS (Not included in spine)
72070 X-RAY EXAM THORAC SPINE 2VWS (spine; thoracic)Entire SpineUse these codes if views of the entire spine were done.
CPT codes 72081-72084 is an exam of the entire spine and should be used if applicable. If reporting these codes, you will also have had to do X-rays on the skull; see the description below.
72081 X-RAY EXAM ENTIRE SPI 1 VW (spine, entire thoracic and lumbar, including skull, cervical and sacral spine).
Dec 7th, 2022 - ALRheum 1
re: Billing multiple Spine xray
Thank you so much for that information. I had read about the x-rays and views however we have had some denials and our clearinghouse always rejects them. I will give my billing team the information and we will go from there, I'll just push the claims through that have neck and lumbosacral views.I really appreciate it!