Billing for chest X-rays, such as CPT code 71045, may seem straightforward. However, there are several factors to consider. Proper billing and documentation are integral to preventing payment delays and denials.
This procedural code is vital for diagnosing and monitoring a wide range of conditions, from suspected pneumonia to post-trauma evaluations. Thus, radiologists need to understand what it covers and how to accurately report it to achieve a healthier revenue cycle.
Luckily, this guide will cover everything you need to know, from real-world clinical scenarios to applicable modifiers and reimbursement guidelines.
So, if you are a radiologist or a radiology center requiring guidance to streamline your billing workflow for chest X-ray procedures, read this guide till the end!
CPT Code 71045 – Description
CPT code 71045 covers a single-view chest X-ray. Physicians primarily order this procedure to evaluate the conditions affecting the chest, its contents, and nearby structures.
Scenarios Where CPT Code 71045 is Applicable
Let’s review a few real-world clinical scenarios where this procedural code applies:
Suspected Pneumonia
Picture a 44-year-old female patient who comes to the emergency room with a five-day history of high fever, cough, and sharp pain in the chest. She also complains about feeling weak and the worsening of chest pain when she breathes deeply.
The attending physician suspects pneumonia, since he notes a cracking sound in her lower right lung (rales) during the initial physical examination. Thus, he orders a single-view chest X-ray.
The X-ray findings reveal a dense opacity in the lower lobe of the right lung, confirming the diagnosis of pneumonia.
Here, CPT code 71045 applies.
Post-Trauma Evaluation
Consider a 15-year-old boy brought to the clinic following a fall from a bicycle. He complains of experiencing pain and difficulty breathing on the left side of his chest.
The physician suspects a possible pneumothorax (collapsed lung) or rib fractures. Thus, he orders a single-view chest X-ray.
The X-ray image shows a sharp, visible line where the lung has pulled away from the chest wall, confirming the diagnosis.
Here, CPT code 71045 should be reported to bill for the single-view chest X-ray.
Pre-Operative Screening
Imagine a 69-year-old male patient with a history of chronic obstructive pulmonary disease (COPD). He is scheduled for hip replacement surgery.
For context, COPD causes breathing issues since it prevents airflow to the lungs. In the USA, approximately 16 million adults have known COPD.
Back to the scenario! The anesthesiologist requests a pre-operative single-view chest X-ray to determine the patient’s heart size and current lung condition. It is an integral step to identify any acute issues, such as fluid around the heart or a lung infection, to avoid complications during and after surgery.
Here, CPT code 71045 applies.
Applicable Modifiers for CPT Code 71045
The following are some of the modifiers that apply to CPT 71045:
Modifier TC
Are you billing for the facility that owns the equipment and provided the technical support for the single-view chest X-ray? If yes, append modifier TC to CPT code 71045 to highlight that you are only billing for the technical component of the service.
Modifier 26
Did you perform the interpretation of the single-view chest X-ray image, but do not own the equipment? If this is the case, report CPT code 71045 with modifier 26. It indicates to the payer that you are only billing for the professional component of the rendered procedure.
Modifier 59
What happens when you render another significant, separately identifiable procedure (e.g., single-view abdomen X-ray) with the service covered under CPT code 71045 for the same patient on the same day? You report modifier 59 with the service to prevent unnecessary payment cuts due to bundling edits.
CPT Code 71045 – Billing & Reimbursement Guidelines
Discussed below are the key billing and reimbursement requirements for a single-view chest X-ray:
Demonstrate Medical Necessity
Establishing medical necessity is the most critical billing requirement, regardless of the payer. Simply put, the payer will only reimburse for CPT code 71045 if you render the service to diagnose or monitor a specific condition. That is, your submitted medical claim will result in a denial if you perform a single-view chest X-ray for a routine, asymptomatic screening.
The following is a list of some symptoms/conditions that qualify for a chest X-ray:
- Chest pain or injury
- Fever with other signs of infection
- Known conditions like congestive heart failure (CHF), pneumonia, or COPD
- Persistent cough
- Shortness of breath
Focus on Detailed Documentation
Complete and accurate documentation is another key billing requirement for CPT code 71045. Thus, it must contain the following:
- State the clinical indication of why the physician ordered a chest X-ray. It must link to the patient’s symptoms or diagnosis.
- Describe the procedure details, i.e., clearly specify that the radiologist performed a single-view chest X-ray.
- Attach the detailed report from the radiologist specifying the findings of the X-ray image.
- Include the ordering provider’s review and signature. Explain how the X-ray findings helped the physician in the patient’s treatment plan.
Do Not Bill CPT Code 71045 For Multiple-Views
Note that one common billing mistake is trying to report CPT 71045 for multiple views of the chest. The reason? The descriptor clearly indicates that this procedural code only covers a single view.
Some may still think to bill multiple units of CPT code 71045 for more than one chest view? If you are in the same boat, stop now! Because there are other, more specific codes available. For instance, CPT 71046 (two-view chest X-ray), CPT 71047 (three-view chest X-ray), and CPT 71048 (four or more views).
Summary
With all the details covered in this comprehensive guide, you can easily streamline your X-ray billing. Before concluding this guide, let’s quickly recap the key takeaways:
First, we explained the descriptor of CPT code 71045. It covers a single-view chest X-ray.
Next, we shared a few clinical scenarios where this code applies. These include pre-operative screening, post-trauma evaluation, and diagnosing suspected pneumonia.
We also listed some of the applicable modifiers related to CPT 71045 and explained their appropriate usage.
Finally, we discussed the key billing and reimbursement guidelines.
Hopefully, this guide will help you overcome the common billing challenges related to single-view chest X-ray billing. However, if you still struggle, consider outsourcing radiology billing services to MediBillMD.
