CPT Code for Chest X-Ray
The CPT code for a standard chest X-ray is 71045 for a single view, 71046 for two views (PA and lateral), or 71047 for three views, with 71046 (two-view chest X-ray) being the most commonly ordered in clinical practice.
Standard CPT Codes for Chest Radiography
- 71045: Radiologic examination, chest; single view
- 71046: Radiologic examination, chest; 2 views (most common - typically posteroanterior and lateral projections)
- 71047: Radiologic examination, chest; 3 views
- 71048: Radiologic examination, chest; 4 or more views
Context in Granulomatous Disease
In patients with suspected or known granulomatous disease (such as sarcoidosis, tuberculosis, or chronic granulomatous disease), chest X-ray serves as the initial imaging modality for screening and staging, though CT imaging is superior for early detection and disease extent. 1, 2
- Chest X-ray (CXR) is recommended as part of the initial diagnostic workup for sarcoidosis and can demonstrate bilateral hilar adenopathy, upper lobe infiltrates, or diffuse infiltrates 1
- However, CXR may appear normal in up to 37% of sarcoidosis patients at diagnosis who have abnormal findings on CT imaging 2
- CT imaging is significantly more superior than CXR for early diagnosis and staging of granulomatous diseases (p=0.001), and should be considered when clinical suspicion is high despite normal chest radiography 2
Clinical Considerations for Granulomatous Disease
When ordering chest imaging for patients with suspected granulomatous disease, consider proceeding directly to CT chest if:
- Clinical suspicion is high despite normal or equivocal chest X-ray findings 2
- Detailed assessment of disease extent, complications, or differential diagnosis is needed 2
- Patient has chronic granulomatous disease (CGD), where pulmonary manifestations affect two-thirds of adult patients and invasive fungal infections are frequently asymptomatic (37% of cases) 3
- Monitoring for inflammatory complications in CGD, which have higher incidence in adulthood compared to childhood (0.22 versus 0.07 per year, p=0.01) 3
The choice between initial chest X-ray versus CT should be guided by the clinical context: start with two-view chest X-ray (CPT 71046) for routine screening, but proceed directly to CT chest with contrast if there is high clinical suspicion for granulomatous disease, need for staging, or concern for complications such as fungal infection. 1, 2, 3