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A radiologic examination of the sacrum and coccyx, identified by CPT® Code 72220, involves obtaining a minimum of two views to assess these specific areas of the lower spine. This procedure utilizes X-ray imaging, which employs indirect ionizing radiation to create images of the internal structures of the body. The principle behind X-ray imaging is based on the varying densities and compositions of human tissues, which affect how X-rays are absorbed or transmitted. As a result, some X-rays pass through the body and are captured on a detector, producing a two-dimensional image that reveals the anatomical details of the sacrum and coccyx. Routine views typically include an anteroposterior (AP) or posteroanterior (PA) view of the sacrum, as well as an AP or PA view of the coccyx, along with lateral views of both structures. Proper positioning of the patient is crucial for accurate imaging; for instance, the pelvis must be aligned to ensure that the sacrum and sacroiliac joints appear symmetrical in the images. Given the unique curvature of the coccyx, additional positioning may be required to visualize it adequately during the AP view of the sacrum. In lateral views, the patient is positioned sideways with feet shoulder-width apart and arms crossed at the shoulders, allowing for a comprehensive view of the lumbar vertebra, sacrum, and coccyx. To achieve optimal imaging results, patient preparation is essential. This includes ensuring the bladder is empty, the colon is clean, and the patient is dressed in a gown rather than regular clothing, as these factors can obstruct the view and compromise the quality of the radiographic images. Additionally, while shielding is typically applied for male patients to protect reproductive organs from radiation exposure, it is not feasible for female patients due to anatomical considerations.
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The radiologic examination of the sacrum and coccyx, coded as CPT® 72220, is indicated for various clinical scenarios. These may include:
The procedure for a radiologic examination of the sacrum and coccyx involves several key steps to ensure accurate imaging. First, the patient is positioned appropriately to obtain the necessary views. For the anteroposterior (AP) view of the sacrum, the patient lies supine on the examination table, and the pelvis is adjusted to ensure that the sacrum and sacroiliac joints are symmetrical. This positioning is critical for obtaining a clear image of the sacrum. Next, the X-ray technician will take the AP view of the coccyx, which may require the patient to be repositioned slightly to visualize the coccyx effectively, given its forward curvature relative to the sacrum. Following these views, lateral images are captured. For the lateral view, the patient stands sideways with their feet shoulder-width apart and arms crossed at the shoulders. This position allows for a comprehensive view of the entire 5th lumbar vertebra, the sacrum, and the coccyx, providing essential information for diagnosis. Throughout the procedure, patient comfort and safety are prioritized. The technician will ensure that the patient is adequately prepared, which includes having an empty bladder and a clean colon to avoid obstructions that could interfere with the imaging process. Additionally, the patient is provided with a gown to wear during the examination, as clothing can obscure the necessary anatomical structures. Shielding is applied for male patients to protect reproductive organs from radiation exposure, while female patients may not receive shielding due to anatomical constraints.
After the radiologic examination of the sacrum and coccyx is completed, the patient may be instructed to resume normal activities unless otherwise advised by their healthcare provider. There are typically no specific post-procedure care requirements, as the procedure is non-invasive and does not involve any recovery time. However, patients may be advised to follow up with their physician to discuss the results of the imaging and any further diagnostic or treatment options that may be necessary based on the findings. It is also important for patients to report any unusual symptoms or discomfort following the procedure to their healthcare provider.
| Short Descr | X-RAY EXAM SACRUM TAILBONE | Medium Descr | RADEX SACRUM & COCCYX MINIMUM 2 VIEWS | Long Descr | Radiologic examination, sacrum and coccyx, minimum of 2 views | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 1 - Diagnostic Tests for Radiology Services | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | STV-Packaged Codes | ASC Payment Indicator | Packaged service/item; no separate payment made. | Type of Service (TOS) | 4 - Diagnostic Radiology | Berenson-Eggers TOS (BETOS) | I1B - Standard imaging - musculoskeletal | MUE | 1 | CCS Clinical Classification | 226 - Other diagnostic radiology and related techniques |
| 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician | TC | Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles | FY | X-ray taken using computed radiography technology/cassette-based imaging | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | LT | Left side (used to identify procedures performed on the left side of the body) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | CR | Catastrophe/disaster related | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | GA | Waiver of liability statement issued as required by payer policy, individual case | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | FX | X-ray taken using film | GP | Services delivered under an outpatient physical therapy plan of care | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GZ | Item or service expected to be denied as not reasonable and necessary | KX | Requirements specified in the medical policy have been met | MA | Ordering professional is not required to consult a clinical decision support mechanism due to service being rendered to a patient with a suspected or confirmed emergency medical condition | MH | Unknown if ordering professional consulted a clinical decision support mechanism for this service, related information was not provided to the furnishing professional or provider | PC | Wrong surgery or other invasive procedure on patient | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q5 | Service furnished under a reciprocal billing arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | RT | Right side (used to identify procedures performed on the right side of the body) | T1 | Left foot, second digit | UD | Medicaid level of care 13, as defined by each state | UH | Services provided in the evening | X1 | Continuous/broad services: for reporting services by clinicians, who provide the principal care for a patient, with no planned endpoint of the relationship; services in this category represent comprehensive care, dealing with the entire scope of patient problems, either directly or in a care coordination role; reporting clinician service examples include, but are not limited to: primary care, and clinicians providing comprehensive care to patients in addition to specialty care | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2013-01-01 | Changed | Short Descriptor changed. |
| 2009-01-01 | Changed | Code description changed |
| Pre-1990 | Added | Code added. |
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