A simple neck X-ray can be a source of confusion while billing for radiology services, leading to a higher denial rate and a strained revenue cycle. Why? The difference between a single-view, a two-view, or a complete study can change which CPT code to report.
Thus, our billing specialists at MediBillMD decided to empower radiologists by offering a detailed and clear roadmap for accurately reporting an X-ray service covered under CPT code 72040.
This guide will discuss clinical scenarios, guidelines, and modifiers to help you code with confidence and receive timely reimbursement.
CPT Code 72040 – Description
CPT code 72040 covers two (2) or three (3) view X-ray of the neck vertebrae. It is an integral diagnostic tool that physicians often use to quickly and non-invasively evaluate traumatic injuries and chronic conditions like arthritis.
Scenarios Where CPT Code 72040 is Applicable
The following are a few real-world clinical scenarios where CPT 72040 applies:
Persistent Neck Pain
Picture a 48-year-old male patient who visits his primary care physician. He complains of experiencing persistent neck pain and stiffness that has worsened over the past few months. He also reports a tingling sensation in his arms.
Thus, the physician orders a two-view X-ray of the neck, suspecting cervical spondylosis (arthritis of the neck) or a herniated disc that is compressing a nerve. The findings of the X-ray image will help the physician evaluate for degenerative changes, e.g., narrowing of disc spaces or bone spurs.
Here, CPT code 72040 applies.
Whiplash Injury
Consider a 27-year-old female patient who has come to the clinic following a minor rear-end collision. She complains of experiencing headaches, neck pain, and muscle spasms.
Thus, the healthcare provider orders a two-view X-ray since he suspects a whiplash injury. Besides, the findings will help him rule out any fractures and other bone-related injuries.
The X-ray images reveal loss of the neck’s normal curvature and confirm a muscle spasm following a whiplash injury.
Here, the radiologist will report CPT code 72040 to bill for the service.
Post-Trauma Evaluation
Imagine a 28-year-old male patient brought to the emergency room following a car accident. He complains of experiencing severe neck pain. Other symptoms include tenderness and a limited range of motion in his cervical spine.
Thus, the attending physician orders a three-view cervical spine X-ray to rule out subluxations, fractures, or dislocations of the neck vertebrae.
Fortunately, the X-ray images show no acute fractures. Here, CPT code 72040 applies.
Applicable Modifiers for CPT Code 72040
Here are some modifiers that apply while billing for two or three-view neck vertebrae X-ray:
Modifier 26
Did you perform only the interpretation of the X-ray images? If yes, append modifier 26 to CPT code 72040 to indicate to the payer that you are billing for the professional component of the service.
Modifier 59
What happens when you perform more than one X-ray for the same patient on the same day? You append modifier 59 to bypass the bundling edit and ensure separate reimbursement for both procedures.
Here, let’s assume a scenario for better understanding. A male patient comes to the urgent care clinic with two distinct complaints. These include a sharp lower back pain that started after a recent fall and a whiplash injury that occurred from a car accident the previous day.
First, the physician examines the patient’s neck and orders a 3-view X-ray of the cervical vertebrae to evaluate the whiplash injury. After reviewing the neck injury, the provider separately examines the patient’s lower back and orders a two-view X-ray of the lumbar spine.
Since the radiologist rendered both X-rays on the same day, he will bill the services as CPT code 72040 and 72100-59.
Modifier TC
Radiology centers or hospital facilities that own the equipment, supplies, and other resources required to perform the X-ray of the neck vertebrae primarily use modifier TC. It highlights to the payer that you are only billing for the technical component of CPT code 72040.
CPT Code 72040 – Billing & Reimbursement Guidelines
Streamline billing and ensure a healthier revenue cycle by understanding the essential guidelines discussed below:
Establish Medical Necessity
Like any other diagnostic procedure, the neck vertebrae X-ray covered under CPT code 72040 must be medically necessary.
That is, whether the patient is enrolled in a federal program (Medicare, Medicaid) or a private insurance plan, you cannot bill this code for a routine, asymptomatic screening.
Thus, the patient’s symptoms and the physician’s diagnosis must justify the need for ordering the X-ray. Some of the clinical indications that demonstrate the medical necessity of performing a neck vertebrae X-ray (two or three-view) are listed below:
- Known conditions like arthritis or cervical spondylosis
- Limited range of motion
- Neck pain from an injury
- Radiating pain or numbness in the arms
- Suspected fracture or dislocation
Include Detailed Documentation
Another key requirement to ensure timely reimbursement against CPT code 72040 is comprehensive and accurate documentation. Thus, your patient’s medical record must contain the following:
- An explanation of the reason why the physician ordered the X-ray (clinical indication).
- A detailed report with an interpretation of the findings of the X-ray images.
- The ordering physician’s review and signature. This review should clearly state how the X-ray findings helped in the patient’s treatment plan.
Do Not Report CPT Code 72040 For More Than Three Views
Note that you can only report CPT code 72040 for a two or three-view X-ray of the neck vertebrae. Thus, if the physician orders an X-ray study with more views, choose another relevant code. For instance:
- CPT code 72050: Four or five X-ray views of the cervical spine.
- CPT code 72052: Six or more X-ray views of the cervical spine.
Summary
With that said, we have come to the end of this detailed guide. It is time to conclude it and say adieu, but before that, why not quickly recap everything we discussed?
First, we explained the CPT code 72040 descriptor. It covers a two or three-view X-ray of neck vertebrae.
Next, we shared a few real-world scenarios when this code is rightfully applicable. These include post-trauma evaluation, whiplash injury, and persistent neck pain.
We also listed some of the applicable modifiers for CPT 72040, including 26, 59, and TC.
Finally, we discussed the essential reimbursement guidelines.
This guide has all the information you need for reporting neck vertebrae X-ray procedures. However, if you still find it challenging, consider outsourcing radiology billing services to MediBillMD to streamline your CPT coding.
