CPT Code 72040

CPT Code 72040 Description, Guidelines, Reimbursement, Modifiers & Example (2022)

CPT code 72040 bills for the service when the Physician performs a radiologic examination of the cervical spine with two or three views.

CPT Code 72040 Description

The following are the reason why the Physician performs cervical spine X-ray:

Pain in the neck, arms, and shoulders.

Tingling or numbness

Cervical vertebrae fracture or dislocation identification

Head injury in an automobile accident

The Physician performs radiologic imaging of the cervical spine, which transfers electromagnetic wave radiation through the patient’s body. These waves generate a scan on X-ray film or a digital sensor. 

The Physician may take a broad series of shoulder images to detect disformity. These images show white bones on x-ray as radiation cannot emit through the bones. The muscles or other tissue may appear black or gray because some waves can pass through.

The Physician may need other studies and x-ray to determine the root cause of the problem, such as MRI, Ultrasound, and CT (computed tomography) scans.

72040 cpt code

CPT code 72040 bills for the service when the Physician performs a radiologic examination of the cervical spine with two or three views.

CPT Code 72040 Billing Guidelines

Documentation should support the medical necessity of service. It reflects that service is medically necessary and appropriate.

If the Physician provides cervical spine x-ray equipment and personnel transportation, It is appropriate to report services with R0070 and R0075. Check the payer guidelines if it is covered or not.

CPT code 72040 includes a minimum number of views or more views when needed to complete the study adequately. If Radiographs repeat during an encounter due to substandard quality, it is appropriate to bill only one unit.

Suppose the Physician Obtains more films after the initial film review, based on the radiologist’s discretion—order for the test and change in patient’s condition.

If the Physician performs a cervical spine x-ray of two or three views, it is appropriate to report with CPT code 72040.

If the Physician performs a cervical spine x-ray of four or five views, it is appropriate to report with CPT code 72050 instead of CPT code 72040.

If the Physician performs a complete cervical spine x-ray of six or more views, it is appropriate to report with CPT code 72052 instead of CPT code 72040. It includes films taken in oblique (angled) positions and flexion and extension positioning.

If evaluation and management service(99202-9999) performs in addition to CPT code 72040, It is appropriate to report CPT code 72040 separately. 

CPT Code 72040 Modifiers

The following are the list modifiers when CPT code 72040 bills:  

22, 23, 26, 50, 52, 53, 58, 59, 76, 77, 78, 79, 99, AI, AQ, AR, CC, CR, ET, EY, FX, FY, GA, GC, GK, GR, GU, GY, GZ, KX, PT, Q5, Q6, QJ, SG, TC, XR, XP, XU, XS, LT, RT

The most frequent bill modifiers are 26, TC, 77, 76, 59, or X {E, P, S, U} with 72040.    

Modifier 26 bills to indicate the professional component of services when attached with 72040. It shows that the Physician work as an employee in a hospital and facility, not owning the equipment.  

Modifier TC applicable with 72040 CPT code indicates the Technical component or machinery used in service. It usually bills with Hospital and facility claims.  

CPT 72040 bills globally when physician-owned the office and equipment. Service bills without TC and 26 modifiers. 

 Modifier 76 is applicable with CPT 72040 when a similar service performs by the Same Physician on the same day.   

Modifier 77 is applicable with CPT code 72040 when a similar service performs by a different Physician on the same service date. 

Modifier 59 is applicable with CPT 72040 when a Distinct service performs by the Physician and bundles with another procedure on the same date.   

Modifier X {E, P, S, U} is applicable instead of Modifier 59 with 72040 CPT code when service bills to medicare insurance. It divides the modifier into four parts for further specification of the procedure. 

If physicians believe that Medicare will deny such service, reporting with a GA  modifier is appropriate. The beneficiary must sign an Advance Beneficiary Notification (ABN), and CPT 72040 must apply the GA modifier to that service. 

Modifier 52 is applicable when the Physician cannot complete the procedure due to unavoidable circumstances.

CPT Code 72040 Reimbursement

A maximum of three units can be a bill on the same service date of CPT code 72040. In contrast, the Three unit allows when documentation supports the medical necessity of the service.  

The cost and RUVS of CPT 72040 with modifier 26 are $11.90 and 0.34388 when performed in the facility. In contrast, the reimbursement and RUVS of 72040 with modifier 26 are $11.90 and 0.34388 when furnished in the non-facility. In OPPS global, the cost and RUVS of CPT 72040 with modifier 26 are $11.90 and 0.34388.

The cost and RUVS of CPT 72040 with modifier TC are $34.82 and 1.00632 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 72040 with modifier TC are $34.82 and 1.00632 when furnished in the non-facility. In OPPS global, the cost and RUVS of CPT 72040 with modifier TC are $96.75 and 2.79571.

In OPPS global, the cost and RUVS of CPT code 72040 with a global modifier are $108.65 and 3.13959. The cost and RUVS of CPT 72040 with global billing are $46.73 and 1.35020 when performed in the facility. In contrast, the reimbursement and RUVS of 72040 with global billing are $40.80 and 1.17903 when performed in the non-facility.

CPT codes  72040–72052 have both a technical and professional component. To report only the technical part, append modifier TC. If the Physician performs the professional role only, append modifier 26. Submit without a modifier to bill the complete procedure (i.e., professional and technical features).

CPT Code 72040 Examples

The following are examples of CPT code 72040 when performed by the Physician:

Example 1

A 60-year-old female presents with neck pain for four days to the office. The pain gets worse with movement and when lying down. The patient took some medication for pain. 

The physical exam revealed swelling in the Cervical region. The Physician ordered a CT and X-ray of the Cervical spine. It shows degeneration of the cervical spine at C1 – C4, C5– C7, and disk budging at the C5-C6 level.

The patient also has spondylosis of the cervical spine. The patient denies any other symptoms such as headache, numbness, urinary problems, nausea, vomiting, and shortness of breath. 

The Physician administers the steroid injection via transforaminal epidural space for pain management. 

Example 2

Today, a sixteen-year-old male presented to the emergency department after a motor vehicle accident and had a severe headache, cervicalgia,  back pain, and chest pain. The patient is unable to move and has severe low back pain

The patient denies urinary symptoms, extremity pain, and dizziness, and the physical exam revealed neck and eye swelling. The Physician ordered a CT and Xrayof the Cervical, head, and chest. 

The patient had multiple fractures of C2-C3 and C5 and C6 levels. The Physician orders an anesthetic agent for pain management of the cervical region.

Example 3 

A 39-year-old male with tumors on the cervical region presented to the emergency department with c/o constant low back pain that started four days ago. The patient was unable to walk for 1-week. 

The patient is consulted with his primary care physician and suggested to go emergency department. Denies trauma, heavy palpitations, dizziness, cough, recent illness, fever, chills, back pain, abdominal pain, nausea, recent travel, known sick contacts, current antibiotic use, near-syncope or syncope, changes in stool color, urinary complaints, or any other symptoms. 

The Physician decides to do a surgical procedure to excise cancer. The patient took his routine medication. The Physician ordered a CT scan and X-ray of the cervical region and laboratory studies to confirm if the tumor metastasized or not. The procedure performs successfully.

 On the second day of surgery, the patient was back with severe pain and decided to administer an anesthetic agent at C4-C5 in the epidural space. 

Example 4

A 76-year-old male presents to the office for radiculopathy and stenosis of the cervical region. A patient has had severe low back pain since last week. 

The patient took some medication for pain but is getting worse day by day. He denies trauma, heavy palpitations, dizziness, cough, recent illness, fever, chills, back pain, abdominal pain, nausea, recent travel, known sick contacts, current antibiotic use, near-syncope or syncope, changes in stool color, urinary complaints, or any other symptoms. 

The X-ray of the cervical region CT scans revealed spondylosis at the C2-C3 level, disc protrusion at the C4-C5 level, and degenerated changes at the C1-C2 region. 

The patient requested the Physician for pain management as he could not bear it. The Physician prescribed medicines for pain and scheduled an appointment for a follow-up visit. The Physician ordered a steroid injection in the epidural space at the C4-C5 level, and he got relief from the pain. 

Example 5

A 65-year-old female presents to the office with neck pain for four days. The pain gets worse with movement and when lying down. The patient took some medication for pain. 

The patient denies any other symptoms such as headache, numbness, urinary problems, nausea, vomiting, and shortness of breath. A physical exam revealed swelling in the Cervical region. 

The Physician ordered an X-ray of the Cervical spine. It reveals degeneration of the cervical spine at C1-C5, C5– C7, and disk budging at the C2-C3 level. The patient also has spondylosis of the cervical spine. The Physician administers steroid injection via transforaminal epidural space for pain management. 

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