CPT 71046 - Chest X-Ray (2 views)

CPT Code 71046: Radiology Billing, Documentation, and Audit Essentials

Optimize your imaging department’s revenue and audit resilience with this guide—made easy with S10.ai AI automation.

Key Information

• Description: Chest X-ray, 2 views
• Setting: Radiology/imaging centers, hospital outpatient
• Use Cases: Pneumonia diagnosis, pre-op assessment, chronic lung disease follow-up

Required Documentation

• Clinical indication for x-ray
• Order from authorized provider
• Detailed radiology report with interpretation and findings
• Patient positioning, number of views documented (must specify 2)

Billing & Payment Strategies

• Typical reimbursement: $26–$60 (payer- and locality-dependent)
• Bill additional codes for interpretation, when provided
• Multiple procedure rule: Use correct modifiers if more than one imaging service

Common Denials

• Missing provider order
• Documentation lacking “2 views” detail
• Bundled with same-day related imaging

What Is CPT Code 71046 and When Should I Use It?

CPT code 71046 is designated for a radiologic examination of the chest that includes two views, typically a posteroanterior (PA) view and a lateral view, to provide a comprehensive image of the thoracic cavity. This code is essential for accurate billing and documentation when a standard two-view chest X-ray is performed to diagnose or monitor a wide range of clinical conditions. Unlike a single-view chest X-ray (CPT 71045), the two-view study provides depth and allows for better localization of abnormalities, making it the standard for initial chest imaging in many clinical scenarios. AI-powered documentation tools can help automatically select the correct CPT code based on dictated findings, reducing administrative burden.

How Do I Justify the Medical Necessity for a 2-View Chest X-Ray?

Justifying the medical necessity for CPT 71046 is critical for reimbursement. Payers, including Medicare, require clear documentation that supports the need for a two-view chest X-ray. Common indications include symptoms such as persistent cough, chest pain, shortness of breath, fever with suspected lung infection, or chest trauma. It is also medically necessary for monitoring conditions like COPD, heart failure, or tracking lung nodule progression. The key is to link the patient's specific symptoms or condition to the need for diagnostic imaging in clinical notes. For example, instead of noting "shortness of breath," a robust entry would be: "Acute onset shortness of breath with rales noted in the left lower lobe on examination, ordering 71046 to evaluate for pneumonia." Templated notes within your EHR, prompted by chief complaints, can ensure consistent documentation.

What Are the Key Differences Between Chest X-Ray CPT Codes?

Chest radiology CPT codes vary based on the number of views taken. CPT 71045 is for a single view, 71046 for two views, 71047 for three views, and 71048 for four or more views. The code is determined by the documented views in the radiology report, not just the number of images obtained. For instance, multiple images to achieve one clear PA view count as a single view. Accurate coding requires precise documentation of the views performed (e.g., "PA and lateral views").

Can I Bill for a Chest X-Ray During a Related Procedure?

Per CMS guidelines, a chest X-ray to confirm tube or catheter placement is often considered integral to the primary procedure (e.g., endotracheal intubation, CPT 31500) and should not be billed separately. Check the National Correct Coding Initiative (NCCI) edits, updated quarterly, to determine if CPT 71046 is bundled with another procedure. Billing software with NCCI edit integration, like Zapier-integrated systems, can provide real-time alerts to prevent unbundling errors.

What Documentation Is Crucial for CPT 71046 Reimbursement?

Inadequate documentation is a leading cause of claim denials for CPT 71046. Compliant records must include a physician’s order, clinical indication, radiology report detailing the views taken, and the interpretation of findings, signed by the interpreting provider. The documentation should clearly show how the imaging results will manage the patient’s medical problem. AI scribes can capture the full narrative of patient encounters, ensuring medical necessity and the physician’s thought process are thoroughly documented to strengthen claims against audits.

How Are Professional and Technical Components Billed for 71046?

CPT 71046 has a professional component (PC) for the radiologist’s interpretation and a technical component (TC) for equipment, supplies, and technologist time. If you own the X-ray equipment and your radiologist interprets the image, bill the global code (71046 without a modifier). If an outside radiologist interprets the image, bill 71046-TC, and the radiologist bills 71046-26 (professional component modifier).

What Are Medically Unlikely Edits (MUEs) for CPT 71046?

Medically Unlikely Edits (MUEs) are Medicare’s automated edits to prevent improper payments. For CPT 71046, the MUE is 2, meaning more than two 2-view chest X-rays on a single date of service are generally not considered medically necessary and may trigger denials. Exceeding this limit requires strong documentation for appeals. Tools like Ahrefs can help research billing questions and MUEs to ensure compliance.

How Can I Optimize My Workflow for Ordering and Reviewing Chest X-Rays?

A standardized workflow improves efficiency in ordering, tracking, and reviewing CPT 71046 chest X-rays. Use integrated EHR ordering with pre-populated patient data, a robust PACS for immediate image viewing and comparison, and automated task management (e.g., via Zapier) to notify clinicians when reports are available. This ensures critical findings are addressed and patients are informed promptly.

Why S10.ai Makes a Difference

• Pre-bill alerts for missing orders or report details
• Modifier usage suggestions
• Integration with EMR/RIS to ensure claim completeness

Power your radiology billing workflow with S10.ai’s advanced AI billing and audit solutions. Revenue and compliance, guaranteed.