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Radio imaging

SuperCoder Posted Tue 27th of November, 2012 10:21:47 AM

Is there any change in radiology imaging codes in 2012? I recently reported 72114 for 4 x-ray views, but payer rejected the claim. Am I billing wrong code?

SuperCoder Answered Tue 27th of November, 2012 11:39:32 AM

To report 72114 for a lumbosacral spine X-ray performed in 2012, you must comply with a new requirement for a "minimum of 6 views":

2011: 72114, Radiologic examination, spine, lumbosacral; complete, including bending views
2012: 72114, Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views.

As shown above, the 2012 code will apply to six or more views while the 2011 definition of 72114 did not include any specific number of views.

Some physicians now document "complete including bending views," rather than stating the number of views, is creating problem while code.

Solution: This change is going to require physician education to ensure coders are given enough information to support this code. Stating the precise number of views has always been a documentation best practice, but this change for 2012 makes documenting those views an absolute must. Alert your physicians and techs to the new requirement, and ask for documentation of the number of views, as well as the type of views, so you can support use of 72114.

Example: The radiologist’s note documents performance and interpretation of the following views:

AP (anteroposterior)
Lateral
Flexion
Extension
LPO (left posterior oblique)
RPO (right posterior oblique)
Left bending view
Right bending view.

Because the documentation meets the minimum of six views and includes bending views, you should select 72114. (Reminder: Because the code covers a "minimum of 6 views," you should not report any views beyond the first six with a separate code. A single unit of 72114 will cover all of the lumbosacral spine X-ray views.)

2 Views Will Now Suffice for 72120

If you’re unhappy about the new minimum view requirement for 72114, you may be cheered by the change to 72120. CPT® 2012 actually reduces the required number of views for 72120 from "minimum of 4" to "2 or 3":

2011: 72120, Radiologic examination, spine, lumbosacral, bending views only, minimum of 4 views
2012: 72120, Radiologic examination, spine, lumbosacral, bending views only, 2 or 3 views.

This change is in line with current practice because physicians frequently don’t require four views to capture what they need to see.

Whenever bending views are ordered, they are almost certain to require/order at least two views. So meeting the requirements of 72120 will be much easier in 2012.

Example: The radiologist documents interpretation of a left bending view and a right bending view taken at a facility. To code the professional component only, you should report 72120-26 (Professional component).

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