CPT Codes 72170, 72180, and 72190

Radiological examinations of the pelvis

Summary:

In 1997, cpt code 71280 was deleted, and the primary codes for X-Ray exam of pelvis through radiologic examination are primarily billed through either 72170, 72170 TC, 72170 modifier 26; or 72190, 72190 TC, and 72190 modifier 26. Learn about all three of these codes in this article, and when it is appropriate to bill or pay out claims for this patient service.

What is CPT Code 72170, 72180, 72190

CPT codes 72170, 72180, and 72190 refer to X-ray exams of the pelvis and hips. CPT 72170 is used for a single view of the pelvis, CPT 72180 (now deleted) was previously used for a complete study of the pelvis, and CPT 72190 covers an X-ray of both hips with the pelvis. Although 72180 is no longer valid, understanding how these codes differ helps ensure correct documentation and billing for pelvic and hip radiographs.

Comparing cpt descriptions and timelines for 72170, 72180, 72190

Adjudication Details for 72170 and 72190

The screen from our Virtual AuthTech coding software, which draws from AMA licensing and directly from approved CMS guidelines, shows that there is no difference in the adjudication details. Both are enforcing and requiring the same global periods, CMS adjustments, Information, possible flags, and Modifiers (26, TC, being the primary considerations).

CMS payment rates for cpt codes 72170 and 72190

Since cpt code 72190 is 3 or more views, while 72170 is 1-2 views, 72190 will obviously be paid more, but the amount is likely to be only $8.00 to $25.00, depending upon your GPCI. In the images below, we show you that by going into Virtual AuthTech you can set your CMS payment rate at 80% or 110% and compare the two.

APC and ASC guides for 72170 vs 72190

There is no discernable difference in APC and ASC regarding codes 72170 and 72190. However, the key difference is when you get into APC Bundled codes; 72190 is a bundled code (upcoded) from 72170. Hence, if you're a biller or a payer claims examiner, you should never submit nor pay a claim that has both a 72170 and 72190.

CCI edits and Related codes for 72170 and 72190

Outpatient CCI bundled codes can be tricky. CPT code 72170 has three related bundled codes to be considered: 36591, 36592, and 96523. CPT code 72190 has the same three bundled codes as 72170 but adds 96523 (irrigation of implanted vascular access device).

What ICDs can be used for 72170 and 72190?

Remember that 72190 is merely an upcoded 72170, right? Wrong.

72170 cpt code has 111 potential ICDs that warrant this procedure, while 72190 cpt code has only 83 ICDs that are applicable.

In the process of upcoding, there are many codes where a previous diagnosis will not provide medical necessity to perform the next elevated procedure or medical task.

Common Mistakes for billing and paying 72170 vs 72190

CPT codes 72170 and 72190 are often billed from the wrong place of service (POS), especially when imaging is performed outside of a hospital radiology department. The most common errors occur when clinics or urgent care centers submit these codes under POS 11 (Office) or POS 20 (Urgent Care) instead of POS 22 (Outpatient Hospital) or POS 23 (Emergency Room), where the actual X-ray was taken.

For example:

• A primary care clinic orders the exam but the hospital radiology department performs it — the claim must reflect POS 22, not the clinic’s office code.
• An urgent care provider performs the film in-house — POS 20 is correct.
• A freestanding imaging center bills for the X-ray directly — use POS 49 (Independent Clinic) or POS 11 depending on ownership and setting.

Ensuring the correct POS aligns with the billing entity and the location of the equipment used, which helps avoid denials and incorrect payment rates.

Summary of CPT Codes 72170, 72180, and 72190

• First off, we hope no one is billing or paying out 72180 cpt code, as it has been deleted since 1997.
• With that out of the way, 72170 is 1-2 views, while 72190 is three or more views.
• 72190 cpt code will have increased documentation and fewer ICDs that are allowed due to upcoding/increased procedure coding.

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