Ask The Expert

This month’s selection:

I am not a certified coder, but I’ve been doing coding for my company for five years or so. The reports we get from the doctors’ offices usually specify seven views of C spine, two views of T spine, and seven views of L spine. I’ve always used 72114 for seven views of the lumbar spine and 72052 for seven views of the C spine. Then, our certified coder started coding seven views of the L spine as 72110. I questioned my supervisor about this and was told that there were changes to the CPT book and that we now can only bill the 72114 if the report specifies that bending views were performed.

Using logic, I determined the changes to mean that the difference was not that bending views be specified but that the number of views be specified. But I asked the X-ray tech in the doctor’s office for clarification. I asked whether the seven views always included the bending views; the X-ray tech confirmed that it did.

So what is the skinny? Should we have been documenting each type of view performed all along and only as of 2012 did we need to document the number of views? Or is documenting that seven views were performed also documenting that bending views were performed? Since seven views always includes bending views, documenting that bending views were performed separate of the number of views is redundant.

To me, it’s like saying we X-rayed five fingers on the left hand but then having to specify whether the pinky was included.

Emily Kuntz
Medical biller/coder

Response:

Yes, in order to assign code 72114 there must be documentation of at least one bending view. (Note that flexion and extension views qualify as bending views.) The bending view is specifically mentioned as a requirement in the code definition. Therefore, if the report includes the number of views but does not state that a bending view was performed, then the exam must be “down-coded” to 72110, which does not require a bending view.

In order to avoid problems in an audit situation, it’s important to ensure the radiology report contains enough information to support the specific CPT code that is billed, even if it is the facility’s standard procedure to always perform the views required for that CPT code.

— Jackie Miller, RHIA, CCS-P, CPC, is an AHIMA-approved ICD-10-CM trainer and vice president of product development at Coding Strategies.