Do you know how to bill a simple chest X-ray? Or like other billers, you also get confused between the different codes for this procedure and the documentation requirements? In both cases, let’s update your knowledge.
CPT code 71046 is frequently used in radiology practices to bill chest X-rays. However, despite its frequent use, many 71046 claims are rejected by insurance payers. Why? Mostly because of documentation errors and failure to justify medical necessity.
That’s why we have included this important code in our ‘CPT Codes’ series. So, let’s start.
CPT Code 71046 – Description
CPT code 71046 is defined as:
“Radiologic examination, chest; 2 views”
Let’s break this down in more detail.
Code 71046 is used to bill a simple chest X-ray using two views. One view is usually taken from the front (posteroanterior or PA view) and the other from the side (lateral view). The two views provide detailed images of the chest cavity and its organs, including lungs, heart, and surrounding structures.
71046 is part of a group of four codes specific to chest X-ray. To clarify any confusion between the codes, we have provided a brief distinction between the different chest X-ray CPT codes:
- 71045: Radiologic examination, chest; single view
- 71046: Radiologic examination, chest; 2 views
- 71047: Radiologic examination, chest; 3 views
- 71048: Radiologic examination, chest; 4 or more views
Please note that X-rays conducted under CPT code 71046 are for diagnostic and treatment purposes only. Routine scans cannot be billed via 71046.
Scenarios Where CPT Code 71046 is Applicable
CPT code 71046 is a commonly used code in radiology practices and laboratories. Physicians can order a chest X-ray for a variety of medical issues like pulmonary and cardiac diseases, inflammatory diseases and infections, trauma in the chest and upper abdomen, malignant and metastatic diseases, and even allergic reactions. The following are a couple of scenarios where this code is rightfully applicable.
Rib Fracture
Let’s take an example of a 40-year-old construction worker. He comes to the outpatient unit complaining of persistent chest pain, especially when he breathes. The patient tells the physician that two days ago, he fell from a scaffolding while working. Initially, he dismissed the symptoms as minor bruising. However, the pain has worsened, and he now experiences difficulty breathing.
The physician suspects a broken rib or trapped air outside the lung. To evaluate the chest structures and rule out complications, the physician orders a 2-view chest X-ray. The results show a rib fracture. In this scenario, the radiology lab can use CPT code 71046 to bill the X-ray.
Pneumothorax
Consider a 28-year-old male teacher who presents to the emergency department with the sudden onset of severe chest pain and difficulty breathing that started during his morning jog. He has no significant medical history but describes the pain as sharp and localized to the left side of his chest.
The attending physician considers spontaneous pneumothorax, particularly given his tall, thin build and the acute presentation. To assess lung expansion and identify any collapsed lung tissue, the physician requests a 2-view chest X-ray. The results confirm a small left-sided pneumothorax. The X-ray, in this case, can be billed via CPT code 71046.
Applicable Modifiers for CPT Code 71046
Confused about applicable modifiers? The following modifiers are typically appended to CPT code 71046:
| Modifier | Name | Description |
|---|---|---|
| TC | Technical Component | Applied when billing only for the technical aspects, including equipment, supplies, and the technician’s services. |
| 26 | Professional Component | Used when billing only for the physician’s interpretation and report. |
| 52 | Reduced Services | Applied when the full service cannot be completed due to patient limitations or extenuating circumstances. |
| 59 | Distinct Procedure | It is used when the procedure is distinct from other services performed on the same day. |
CPT Code 71046 – Billing & Reimbursement Guidelines
Here are a few billing and reimbursement guidelines you must follow to avoid claim denial for CPT code 71046:
Justify Medical Necessity
The Centers for Medicare and Medicaid Services (CMS) has not provided any list of valid diagnoses or ICD-10 codes for CPT code 71046. So, denials are rampant for this code. But what many billers don’t know is that CMS has provided a list of ICD-10 codes that cannot be used with 71046. The following are some of these:
- D64.9: Anemia, unspecified
- I70.90: Unspecified atherosclerosis
- M06.9: Rheumatoid arthritis, unspecified
- M54.50: Low back pain, unspecified
- M54.51: Vertebrogenic low back pain
- R41.82: Altered mental status, unspecified
You can check out the complete list of ICD-10 codes that do not support medical necessity criteria in the CMS’s chest X-ray guidelines.
Provide Comprehensive Documentation
All medical claims require detailed documentation for approval. If you don’t append the relevant medical records and documents, your claims will be rejected. Do you know that the top 3 denial reasons for 71046 are all related to documentation issues? The following errors lead to denials:
- Failure to return records
- The documentation submitted was incomplete and/or insufficient
- The documentation submitted does not support medical necessity
Based on the CMS chest X-ray policy, the following documentation is required for 71046:
Request for Procedure
- Written or electronic request must include:
- Signs and symptoms
- Relevant history (including known diagnoses).
- Specific reason for the exam or provisional diagnosis for proper performance/interpretation
Stable, Asymptomatic Cardiac or Pulmonary Disease
- Clinical chart must document:
- Reason(s) for the radiograph(s)
- How the physician will use X-ray results in patient care
Pre-Procedural Chest X-Ray in Stable, Asymptomatic Patients
- Clinical chart must document:
- Reason(s) for the X-ray
- How results will guide patient care (e.g., surgical planning in ASC/outpatient)
Symptomatic Cardiac or Pulmonary Conditions (e.g., Pre-Surgery)
- For symptoms such as worsening cough, orthopnea, dyspnea on exertion, or decreased SaO2:
- Documentation must explain how X-ray results will influence treatment decisions
Confirm the Medicare Reimbursement Rates
The reimbursement amount for CPT code 71046 varies for each MAC locality. The national average reimbursement amount for 71046 is $32.67 in non-facility settings.
The following is a more detailed breakdown of the cost structure:
Professional component:
- Facility price: $10.03
- Non-facility price: $10.03
Technical component:
- Facility price: Not applicable
- Non-facility price: $22.64
You can check the exact reimbursement rate for your MAC locality via the PFS Lookup Tool.
Wrapping Up
CPT code 71046 is a frequently used billing code in radiology practices. So, claims must be submitted with care. Otherwise, you can lose a significant amount of revenue. If you follow the guidelines that we provided in this blog, you can achieve a good first-pass ratio.
While you can significantly improve your billing by following our guidelines, some things are better left to experts. MediBillMD’s specialized radiology billing services offer guaranteed reduction in claim denials and a boost to your revenue.
