AHA Coding Clinic® for HCPCS - 2018 Issue 1; Ask the Editor

Confirmatory chest X-ray

Please clarify if the coding instruction provided in AHA Coding Clinic for HCPCS 3Q 2015 and Coding Clinic for HCPCS 2Q 2014 continues to apply in 2017 as it relates to hospital-based NCCI edits for chest X-rays that are used to confirm placement of endotracheal tubes or chest tube insertions. Is it appropriate for the hospital to report 31500 and 71010-59 when the chest X-ray is used to confirm placement of the ET tube? These code pairs are listed in the 2017 NCCI PTP edits as a misuse of column 2 with column 1 code. So in what circumstance is it not appropriate for the hospital to report a chest X-ray with modifier 59 when an ET tube is inserted? The CMS NCCI Policy Manual Chapter 9 was updated effective 1/1/2017 to include the following language in section C.3: When a comparative imaging study is performed to assess potential complications or completeness of a procedure (e.g., post-reduction, post-intubation, post-catheter placement, etc.), the professional component of the CPT code for the post-procedure imaging study is not separately payable and should not be reported. The technical component of the CPT code for the post-procedure imaging study may be reported. However, the NCCI Policy Manual Chapter 9 Section C.9 states: When a central venous catheter is inserted, a chest radiologic examination is usually performed to confirm the position of the catheter and absence of pneumothorax. Similarly when an emergency endotracheal intubation procedure (CPT code 31500), chest tube insertion procedure (e.g., CPT codes 32550, 32551, 32554, 32555), or insertion of a central flow directed catheter procedure (e.g., Swan Ganz) (CPT code 93503) is performed, a chest radiologic examination is usually performed to confirm the location and proper positioning of the tube or catheter. The chest radiologic examination is integral to the procedures, and a chest radiologic examination (e.g., CPT codes 71045, 71046) should not be reported separately. Please clarify this guidance for us. ...

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