How To Use CPT Code 72040

CPT 72040 is a radiologic examination code for cervical spine with 2 or 3 views. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 72040 procedures.

1. What is CPT 72040?

CPT 72040 is a medical billing code used to describe a radiologic examination of the cervical spine, specifically involving 2 or 3 views. This code is used by medical coders and billers to accurately document and bill for this specific type of radiologic examination.

2. 72040 CPT code description

The official description of CPT code 72040 is: “Radiologic examination, spine, cervical; 2 or 3 views.”

3. Procedure

The 72040 procedure involves the following steps:

1. The patient is positioned appropriately for the X-ray examination.
2. A technician operates the X-ray machine to capture 2 or 3 different views of the cervical spine.
3. Typical views include a true lateral view (which includes all seven cervical vertebrae as well as the C7-T1 junction from the side), an AP view (front to back), and an open-mouth odontoid view.
4. A physician interprets the X-ray views and provides a formal written report of the findings.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 72040 services are those who require a radiologic examination of their cervical spine for diagnostic purposes. This may include patients with neck pain, suspected cervical spine injuries, or other conditions that warrant a detailed examination of the cervical spine.

5. When to use CPT code 72040

It is appropriate to bill the 72040 CPT code when a patient undergoes a radiologic examination of their cervical spine with 2 or 3 views. This code should be used to accurately document and bill for this specific type of radiologic examination.

6. Documentation requirements

To support a claim for CPT 72040, the following information should be documented:

• The patient’s medical history and reason for the examination.
• The specific views taken during the examination (e.g., true lateral view, AP view, open-mouth odontoid view).
• A detailed description of the findings from the examination, including any abnormalities or concerns.
• A formal written report of the findings, signed by the interpreting physician.

7. Billing guidelines

When billing for CPT code 72040, keep the following guidelines in mind:

• If you are reporting only the physician’s interpretation for the radiology service, append professional component modifier 26 to the radiology code.
• If you are reporting only the technical component for the radiology service, append modifier TC to the radiology code. Note that payer policy may exempt hospitals from appending modifier TC because the hospital’s 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.

8. Historical information

CPT 72040 was added to the Current Procedural Terminology system on January 1, 1990. There have been several updates to the code since its addition:

• Code Changed on 01-01-2001: Radiologic examination, spine, cervical; anteroposterior and lateral
• Code Changed on 01-01-2009: Radiologic examination, spine, cervical; two or three views
• Code Changed on 01-01-2013: Radiologic examination, spine, cervical; 2 or 3 views
• Code Changed on 01-01-2014: Radiologic examination, spine, cervical; 3 views or less

9. Similar codes to CPT 72040

Five similar codes to CPT 72040 and how they differentiate are:

1. CPT 72050: This code is for a radiologic examination of the cervical spine with a minimum of 4 views.
2. CPT 72052: This code is for a radiologic examination of the cervical spine with a minimum of 5 views, including oblique and flexion and/or extension views.
3. CPT 72070: This code is for a radiologic examination of the thoracic spine with 2 views.
4. CPT 72072: This code is for a radiologic examination of the thoracic spine with a minimum of 3 views.
5. CPT 72074: This code is for a radiologic examination of the thoracic spine with a minimum of 4 views, including oblique and flexion and/or extension views.

10. Examples

Here are 10 detailed examples of CPT code 72040 procedures:

1. A patient with chronic neck pain undergoes a 2-view cervical spine X-ray to evaluate for possible degenerative changes.
2. A patient with a history of rheumatoid arthritis has a 3-view cervical spine X-ray to assess for possible joint damage and instability.
3. A patient who experienced a fall and has neck pain undergoes a 2-view cervical spine X-ray to rule out a fracture.
4. A patient with a suspected cervical spine infection has a 3-view cervical spine X-ray to evaluate for possible bone involvement.
5. A patient with a history of cervical spine surgery undergoes a 2-view cervical spine X-ray to assess for postoperative complications.
6. A patient with a known cervical spine tumor has a 3-view cervical spine X-ray to monitor the progression of the tumor.
7. A patient with a suspected cervical spine dislocation undergoes a 2-view cervical spine X-ray to confirm the diagnosis.
8. A patient with a history of whiplash injury has a 3-view cervical spine X-ray to evaluate for possible ligamentous injury.
9. A patient with unexplained neurological symptoms undergoes a 2-view cervical spine X-ray to assess for possible spinal cord compression.
10. A patient with a suspected cervical spine malformation has a 3-view cervical spine X-ray to evaluate the extent of the abnormality.