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Chest x ray and lung cancer

Today is world lung cancer day. Let take a look of potential lung cancer patient.

patient: Cough,Hemoptysis, Bronchial obstruction, pneumonia, 45 years old smoker

Treatment: chest x ray

Is Preauth Required? Prior authorization justifications for a chest X ray for a cough, hemoptysis, bronchial obstruction, or pneumonia in a 45 year old smoker would include documentation of history, description of the present illness including mechanism of trauma, quality and character of symptoms, onset, duration, intensity, frequency, location, and radiation of symptoms, aggravating or relieving factors, prior interventions, treatments, medications, and symptoms causing the patient to seek treatment. Additionally, clinical evidence from medical societies and clear community standards may be required to support the medical necessity of the chest X ray. Will the claim be denied? A chest x ray may be approved for this condition if it is indicated for making the diagnosis, such as for detecting pneumonia, bronchial obstruction, hemoptysis, etc. However, a chest x ray may be denied if it is not necessary for making the diagnosis and/or if it can be replaced by other available tests or treatments. When is the following treatment medically necessary for the condition specified? A chest X ray is considered medically necessary in the case of a chronic cough, hemoptysis, bronchial obstruction, and pneumonia for a 45 year old smoker. This is because chest X rays can be used to diagnose and aid in treatment decisions for pulmonary diseases, cardiac diseases, infections and inflammatory diseases, chest and upper abdominal trauma situations, malignant and metastatic diseases, and allergic and drug related diseases. In this case, the chest X ray can help to diagnose any underlying pulmonary or cardiac diseases, infections, or trauma. What are the relevant codes for the treatment? The chest x ray should be coded with CPT code 71045 and HCPCS code Q0091, along with the appropriate ICD-10-CM code for the condition (e.g. J44.0 for chronic obstructive pulmonary disease). Modifier -26 (professional component) should be used to indicate that the service is a professional component.

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