CPT code 71023 is for a chest x-ray with fluoroscopy, a diagnostic imaging procedure used to view the lungs and chest in real-time.
CPT code 71023 is used to describe a medical procedure that involves both a chest X-ray and fluoroscopy. This code is specifically for instances where a healthcare provider needs to obtain detailed images of the chest area, which includes the lungs, heart, and surrounding structures. The chest X-ray provides a static image, while fluoroscopy offers real-time moving images, allowing for a more comprehensive examination. This combination is often utilized to diagnose or monitor conditions affecting the chest, such as lung diseases, heart problems, or abnormalities in the chest cavity.
When considering whether CPT codes 71022 and 71023 require any modifiers, it's important to understand the context in which these codes are used and the specific circumstances of the procedure. Here is a list of potential modifiers that could be applied to these codes, along with the reasons for their use:
1. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed. For instance, if a radiologist interprets the chest x-ray but does not own the equipment, this modifier would be appropriate.
2. Modifier TC - Technical Component: This is used when only the technical component of the service is being billed. It applies when the provider owns the equipment and performs the x-ray, but the interpretation is done by another provider.
3. Modifier 59 - Distinct Procedural Service: This modifier may be necessary if the chest x-ray is performed in conjunction with another procedure that is not typically reported together. It indicates that the procedures are distinct and separate.
4. Modifier 76 - Repeat Procedure by Same Physician: If the chest x-ray needs to be repeated on the same day by the same physician, this modifier would be used to indicate that the repeat procedure was necessary.
5. Modifier 77 - Repeat Procedure by Another Physician: Similar to Modifier 76, this is used when the repeat procedure is performed by a different physician on the same day.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although primarily used for laboratory tests, if a repeat x-ray is performed for a clinical reason, this modifier might be applicable to indicate the necessity of the repeat test.
7. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion. For example, if only part of the x-ray series is completed, this modifier would be appropriate.
8. Modifier 53 - Discontinued Procedure: If the procedure is started but discontinued due to patient circumstances or other factors, this modifier would be used to indicate that the procedure was not completed.
9. Modifier 99 - Multiple Modifiers: When more than one modifier is necessary to describe the service, this modifier indicates that multiple modifiers are being used.
These modifiers help ensure accurate billing and reimbursement by providing additional context about the service provided. It's crucial to apply the correct modifiers to avoid claim denials and ensure compliance with payer requirements.
CPT code 71023 is subject to reimbursement considerations under Medicare, specifically through the Medicare Physician Fee Schedule (MPFS). The MPFS outlines the payment rates for services provided by physicians and other healthcare professionals.
Whether CPT code 71023 is reimbursed by Medicare can depend on several factors, including the specific policies of the Medicare Administrative Contractor (MAC) that processes claims in your region. Each MAC may have slightly different guidelines and coverage determinations, so it is crucial to verify with the local MAC to ensure compliance with their specific requirements.
Additionally, reimbursement may be influenced by the medical necessity of the service, as documented in the patient's medical records. Therefore, healthcare providers should consult the MPFS and their regional MAC for the most accurate and up-to-date information regarding the reimbursement of CPT code 71023.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including CPT code 71023, and by individual payer. Schedule a demo today to see how RevFind can help ensure you're receiving the full reimbursement you deserve.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
