How To Use CPT Code 72170

CPT 72170 is a radiologic examination code for the pelvis with one or two views, used to diagnose and treat various conditions. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 72170.

1. What is CPT 72170?

CPT 72170 is a medical billing code used for radiologic examinations of the pelvis, specifically when one or two views are taken. This code is utilized by healthcare providers to diagnose, manage, and treat various conditions related to the pelvic region, such as fractures, swelling, or pain.

2. 72170 CPT code description

The official description of CPT code 72170 is: “Radiologic examination, pelvis; 1 or 2 views.”

3. Procedure

The 72170 procedure involves the following steps:

1. The patient is positioned appropriately for the X-ray examination.
2. The X-ray machine is adjusted to focus on the pelvic region.
3. The provider takes one or two X-ray images of the pelvis, typically from the anteroposterior (front to back) view.
4. The images are recorded on special film or digital format for further analysis.
5. The provider interprets the images to diagnose and manage the patient’s condition.

4. Qualifying circumstances

Patients eligible to receive CPT code 72170 services include those who present with symptoms or conditions that require a radiologic examination of the pelvis. These may include, but are not limited to:

• Pelvic pain or discomfort
• Suspected fractures or dislocations
• Swelling or inflammation
• Abnormal growths or masses
• Postoperative evaluation
• Monitoring of known conditions affecting the pelvis

5. When to use CPT code 72170

It is appropriate to bill the 72170 CPT code when a healthcare provider performs a radiologic examination of the pelvis with one or two views to diagnose, manage, or treat a patient’s condition. This code should be used when the examination is limited to one or two views, rather than a complete examination with a minimum of three views, which would require the use of CPT code 72190.

6. Documentation requirements

To support a claim for CPT 72170, the following information should be documented:

• Patient’s medical history and presenting symptoms or conditions
• Physical examination findings related to the pelvis
• Indication for the radiologic examination
• Number of views taken during the examination
• Technical details of the X-ray procedure, including equipment used and settings
• Interpretation of the X-ray images, including any findings and their clinical significance
• Diagnosis, management, and treatment plan based on the examination results

7. Billing guidelines

When billing for CPT code 72170, keep in mind the following guidelines:

• Append modifier 26 to the radiology code when reporting only the physician’s interpretation of the radiology service.
• Append modifier TC to the radiology code when reporting only the technical component of the radiology service. Note that some payer policies may exempt hospitals from appending modifier TC, as their portion is inherently technical.
• Do not append a professional or technical modifier to the radiology code when reporting a global service in which one provider renders both the professional and technical components.
• Imaging of the pelvis includes both right and left sides, so only report the code once. There is no need to append modifier LT for the left side or RT for the right side, as the standard views show both sides.

8. Historical information

CPT 72170 was added to the Current Procedural Terminology system on January 1, 1990. The code has undergone the following updates:

• Code Changed on 01-01-2001: Radiologic examination, pelvis; anteroposterior only
• Code Changed on 01-01-2009: Radiologic examination, pelvis; one or two views

9. Similar codes to CPT 72170

Five similar codes to CPT 72170 and how they differentiate are:

• CPT 72190: A complete radiologic examination of the pelvis with a minimum of three views.
• CPT 72192: Computed tomography (CT) scan of the pelvis without contrast material.
• CPT 72193: CT scan of the pelvis with contrast material.
• CPT 72194: CT scan of the pelvis with and without contrast material.
• CPT 72195: Magnetic resonance imaging (MRI) of the pelvis without contrast material.

10. Examples

Here are 10 detailed examples of CPT code 72170 procedures:

1. A patient presents with acute pelvic pain following a fall, and the provider orders a one-view X-ray of the pelvis to rule out a fracture.
2. A patient with a history of hip dysplasia requires a two-view X-ray of the pelvis to monitor the condition and plan for potential surgery.
3. A patient complains of chronic pelvic pain, and the provider orders a one-view X-ray of the pelvis to investigate potential causes.
4. A patient with a known pelvic mass requires a two-view X-ray of the pelvis to assess the size and location of the mass.
5. A patient presents with swelling and inflammation in the pelvic region, and the provider orders a one-view X-ray of the pelvis to evaluate the underlying cause.
6. A patient who has undergone pelvic surgery requires a two-view X-ray of the pelvis to assess postoperative healing and alignment.
7. A patient with a history of osteoporosis presents with new-onset pelvic pain, and the provider orders a one-view X-ray of the pelvis to evaluate for potential fractures.
8. A patient with a suspected dislocation of the hip joint requires a two-view X-ray of the pelvis to confirm the diagnosis and plan for treatment.
9. A patient with a known pelvic infection requires a one-view X-ray of the pelvis to assess the extent of the infection and monitor treatment progress.
10. A patient with a history of pelvic radiation therapy requires a two-view X-ray of the pelvis to evaluate for potential radiation-induced changes in bone structure.