Health Information Management

Q/A: Can we report a chest x-ray for ET tube placement in ED?

APCs Insider, July 26, 2013

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Q: Our physicians order a chest x-ray (CPT ® code 71010) after placing an endotracheal (ET) tube (CPT code 31500) during an emergency (such as a code blue) to be sure that the tube is in the correct place. We perform the x-ray and charge for the service. However, this code pair hits an NCCI edit. The edit has a modifier status of 1, so a modifier can be placed. The ET tube was placed in the ED and a radiology tech went to the ED to perform the x-ray; it is radiology’s machine and personnel, so they want the modifier placed so they get paid for their resources. However, I’m not so sure it’s appropriate.

A: When a chest x-ray is performed to check placement of an ET tube, it is part of the emergency intubation procedure because the purpose is to validate the placement. The payment for CPT 31500 (emergency intubation) includes the x-ray. According to the 2013 National Correct Coding Initiative Policy Manual, chapter 9: 

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 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 71010, 71020) should not be reported separately.

The charge for the intubation procedure should be reviewed to insure that the cost/charge for the chest x-ray has been included to insure that all resources expended are being reported.

Editor’s note: Denise Williams, RN, CPC-H, vice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Fla., answered this question.



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