Chest X-ray, 2 views, frontal and lateral; fluoroscopic guidance for procedure or cast
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Chest X-ray views insufficient - only 1 view performed, not 2
Common71046 (chest X-ray 2 views, frontal and lateral) requires documentation of both PA (or AP) frontal view AND lateral view. Denied when only single frontal view performed (bill 71045 instead), when lateral not documented, or when 2 frontal views billed as 2-view study. Medicare allows 71046 only when both views obtained.
Common Causes
- • Radiology report documents 'PA chest X-ray' only - that's single view 71045
- • Two different frontal projections (PA and AP) billed as 2 views - both frontal doesn't qualify
- • Lateral view attempted but not diagnostic quality - can't bill if image inadequate
Resolution Strategy
Verify both views documented: Radiology report must state 'PA and lateral chest radiographs' or 'AP and lateral chest'. Tech notes should document patient positioning for both views. If only frontal view obtained, rebill as 71045 (single view). If patient unable to tolerate lateral positioning, document reason and bill 71045. Cannot appeal 71046 without both frontal and lateral views documented and interpreted. Success rate very low - payers strictly enforce 2-view requirement.
Relative Value Units (RVUs)
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Clinical Information
When to Use
For chest X-ray with fluoroscopic guidance to verify proper positioning of tubes, lines, catheters, or casts
Common Scenarios
Documentation Requirements
- Type of device being verified
- Radiologist's findings and positioning assessment
- Any complications or findings noted
Coding Guidelines
Common Modifiers
Bundling Rules
- May bundle with placement procedure if component
- Includes fluoroscopic real-time guidance
- Interpretation included
Exclusions
- Static CXR without fluoroscopy uses 71020
- Fluoroscopy only without radiograph
- Do not bill with 76000 fluoroscopy code
Coding Notes
Clinical scenarios
- Type of device being verified
- Radiologist's findings and positioning assessment
- Any complications or findings noted
- Type of device being verified
- Radiologist's findings and positioning assessment
- Any complications or findings noted
- Type of device being verified
- Radiologist's findings and positioning assessment
- Any complications or findings noted
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Code Details
Medicare Pricing
PFSRVU Breakdown
OPPS Details
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Ask a QuestionFrequently Asked Questions
CPT 71046 is the billing code for "Chest X-ray, 2 views, frontal and lateral; fluoroscopic guidance for procedure or cast". For chest X-ray with fluoroscopic guidance to verify proper positioning of tubes, lines, catheters, or casts
Medicare pays approximately $32.67 for CPT 71046 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
CPT 71046 has a total RVU of 3.42, broken down as: Work RVU 0.85, Practice Expense RVU 2.48, and Malpractice RVU 0.09. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 71046 is "Chest X-ray views insufficient - only 1 view performed, not 2". 71046 (chest X-ray 2 views, frontal and lateral) requires documentation of both PA (or AP) frontal view AND lateral view. Denied when only single frontal view performed (bill 71045 instead), when lateral not documented, or when 2 frontal views billed as 2-view study. Medicare allows 71046 only when both views obtained. Common causes include: Radiology report documents 'PA chest X-ray' only - that's single view 71045; Two different frontal projections (PA and AP) billed as 2 views - both frontal doesn't qualify. Appeal success rate is approximately 10-30%.
Key documentation requirements for CPT 71046 include: Type of device being verified; Radiologist's findings and positioning assessment; Any complications or findings noted. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 71046: May bundle with placement procedure if component. Includes fluoroscopic real-time guidance Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 71046 include: 26 (Professional component only), TC (Technical component only). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 71046 is Not applicable - imaging study. Time-based codes require documentation of the actual time spent providing the service.