Rib and Chest X-ray (3 views, left side)

What it is

Ribs are curved, they overlap each other, and they lie in front of and behind the lungs at the same time, so a fracture line through one is easy to miss on a single image. A rib series deals with that by taking the affected side from more than one angle, with the body rotated so the ribs in question come clear of the spine and of each other. What distinguishes this particular code is the chest film included with it: a standard view taken from back to front, which shows the lungs rather than the bones. That inclusion is deliberate. A cracked rib is generally treated the same way whether or not it is seen on film, but air or blood collecting around the lung because of the injury changes everything, and the chest view is what looks for it. This code is the left-sided version of the study.

Why it is done

• To look for broken ribs on the left side after a fall, a collision, or a direct blow
• To check the lung beneath them for a collapse, or for blood or fluid gathering in the chest
• To count how many ribs are involved and whether several are broken in more than one place, which is treated differently from a single crack
• To investigate localized chest wall pain that has persisted without a clear injury
• To look at a rib abnormality picked up incidentally on an earlier chest film

What to expect

The technologist has the patient stand or lie against the plate and rotates the torso between exposures — often uncomfortable when the ribs are freshly injured, since the position needed to separate them is usually the position that hurts. Breath-holds are asked for, and for the chest view the patient takes a deep breath in and holds it. The whole study is over in a few minutes. Plain films are known to miss rib fractures, so a normal result does not always mean nothing is broken; when the concern is what is happening inside the chest rather than to the bone, a CT is sometimes done instead or in addition. A radiologist issues the report.

Questions worth asking

• Does the code billed match the side that hurts and the number of views taken? Rib studies are coded by side and by view count, and left, right, and bilateral are all priced differently.
• Was a separate chest x-ray also billed? The chest view is already part of this code, so a second standalone chest film on the same day is worth querying.
• If a follow-up chest film is taken hours later to recheck the lung, is that billed as a new study?
• If a chest CT is ordered after these films, will both appear on the bill in full?