Chest X-Ray Targeted Probe and Educate Review Results

The Jurisdiction E, Part A Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of CPT® 71045 - Radiologic examination, chest; single. The quarterly edit effectiveness results from January 1, 2020 through March 31, 2020 are as follows:

Top Denial Reasons

  • Documentation does not support coverage and medical necessity requirements per LCD.

Educational Resources

Education

Limitations of Coverage for Chest X-rays

Local Coverage Determination (LCD) L37547 provides coverage requirements for chest X-rays. Radiologic examination of the chest (chest X-ray) facilitates the detection, diagnosis, staging and management of pathophysiologic processes involving thoracic, cardiovascular, pulmonary and mediastinal structures, contiguous coverings and the bony thorax. Medicare Part A covers these examinations when medically necessary and appropriate for evaluation and management of a specific symptom, sign, disease or injury.

Routine, screening, pre-operative or periodic examinations in the absence of signs, symptoms, or disease states rarely adds significant clinical information per the cited references in the LCD and therefore will not be reimbursed. Chest X-rays completed solely for the purpose of evaluating minor trauma of the head, lower back or extremities would not be considered medically necessary. Documentation must support the signs and symptoms warranting a chest x-ray or supporting information on how the chest X-ray results will influence treatment of the beneficiary.

Note: Local Coverage Article: Billing and Coding: Chest X-Ray Policy A57497 lists diagnosis codes that do not support medical necessity per standard medical practice. The codes listed are non-covered diagnosis codes.

 

Last Updated Thu, 21 May 2020 21:01:28 +0000