CPT® 2018 Breathes New Life Into Coding For Chest and Lung Tests

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Chest X-rays and pulmonary stress testing are important diagnostic tests, but they’re in the spotlight for a different reason now. CPT® 2018, effective Jan. 1, 2018, gives a makeover to coding for these important chest and lung tests.

CPT 2018 Breathes New Life Into Coding For Chest and Lung Tests

Count on Views to Be the Answer for Chest X-Ray Codes

Doctors order chest X-rays for a lot of reasons, making them a very common test. If you’ve memorized the medical procedure codes for these tests over the years, it’s time to break some habits! The CPT® codes for chest X-rays get a complete overhaul in CPT® 2018.

The 2018 code set deletes 71010-71035 and replaces those codes with streamlined options that keep the focus on the number of views:

  • 71045 (Radiologic examination, chest; single view)
  • 71046 (… 2 views)
  • 71047 (… 3 views)
  • 71048 (… 4 or more views).

The change to focus on number of views, without requiring the type of view to be known, simplifies coding and means coders can spend less time hunting down the type of views before choosing a code.

Don’t miss: Your 2018 CPT® code lookup changes in another way because of the X-ray coding makeover.

Fluoroscopy code 76000 removes the phrase “other than 71023 or 71034” from the descriptor. The reason is that those codes for chest X-ray with fluoro are not valid under CPT® 2018. Here’s how the 2017 and 2018 descriptors compare:

  • 2017: 76000 (Fluoroscopy (separate procedure), up to 1-hour physician or other qualified health care professional time, other than 71023 or 71034 (eg, cardiac fluoroscopy))
  • 2018: 76000 (Fluoroscopy (separate procedure), up to 1-hour physician or other qualified health care professional time).

Check on How MPFS 2018 Affects Chest X-Ray Reimbursement

The 2018 Medicare Physician Fee Schedule (MPFS) reveals the reimbursement you can expect for 2018 chest X-rays. The RVUs are very similar to those for 2017 chest X-rays.

In the table below, you’ll see the relative value units (RVUs) the 2018 MPFS assigns to the global code, the technical component, and the professional component of each new chest X-ray code. When you multiply the total RVUs by the 2018 conversion factor (CF) 35.9996, you get the national rate for the code. The table rounds that amount to two decimal places. (Keep in mind that the final amount you receive will differ based on factors like geographic adjustment.)

CODE MODIFIER TOTAL RVUS RVUS X CF
71045   0.56 20.16
71045 TC 0.30 10.80
71045 26 0.26 9.36
71046   0.86 30.96
71046 TC 0.55 19.80
71046 26 0.31 11.16
71047   1.10 39.60
71047 TC 0.70 25.20
71047 26 0.40 14.40
71048   1.18 42.48
71048 TC 0.72 25.92
71048 26 0.46 16.56


Pick Up on Changes to Pulmonary Stress Testing

Pulmonary stress testing is another common service undergoing major changes in CPT® 2018.

Your CPT® code search in 2017 resulted in these two codes:

  • Simple: 94620 (Pulmonary stress testing; simple (eg, 6-minute walk test, prolonged exercise test for bronchospasm with pre- and post-spirometry and oximetry))
  • Complex: 94621 (… complex (including measurements of CO2 production, O2 uptake, and electrocardiographic recordings)).

But CPT® procedure code lookup for 2018 dates of service reveals two new codes to replace 94620 and a revision for 94621.

In place of 94620, choose between these two codes in 2018:

  • 94617 (Exercise test for bronchospasm, including pre- and post-spirometry, electrocardiographic recording(s), and pulse oximetry)
  • 94618 (Pulmonary stress testing (eg, 6-minute walk test), including measurement of heart rate, oximetry, and oxygen titration, when performed).

The change separates out the test options previously lumped into 94620, allowing more specific coding and payment for each service.

And here’s the new descriptor for 94621: Cardiopulmonary exercise testing, including measurements of minute ventilation, CO2 production, O2 uptake, and electrocardiographic recordings.

Here’s Why Understanding 94617 vs. 94618 Matters

We’ve seen that the 2018 rates for the new chest X-ray codes are similar to 2017 rates. And the same can be said for 94621, which paid roughly $165.09 in 2017 and will pay about $168.48 in 2018.

Don’t miss this: At the end of 2017, the national MPFS rate for 94620 was roughly $57.06. The codes that replace 94620 split, with one going lower and one going higher than the 94620 rate. If you report the wrong code, you’ll either be shortchanging your practice or setting yourself up for a refund to your payer. The new codes describe two distinct tests, with 94617 requiring more work than the 94618 test.

Check the table below for more details. Note that these pulmonary codes have professional and technical components, too.

CODE MODIFIER TOTAL RVUS RVUS X CF
94617   2.70 97.20
94617 TC 1.75 63.00
94617 26 0.95 34.20
94618   0.97 34.92
94618 TC 0.32 11.52
94618 26 0.65 23.40
94621   4.68 168.48
94621 TC 2.72 97.92
94621 26 1.96 70.56