Ask Dr. Z

I hope you can help with this unique request. The patient’s condition warranted a bedside esophagram. Fluoroscopy was NOT used. Instead, the tech used a digital portable x-ray machine with cassette placed behind and on the side of the patient to take 11 or so images in the AP and lateral projections in the chest area. This was done before, during, and after ingestion of contrast material, which was injected via GI tube at the level of mid esophagus by the patient’s physician (not the radiologist). What is the appropriate way to code this? Scout film demonstrates evidence of pneumomediastinum and soft tissue emphysema in the neck and supraclavicular regions. No pneumothorax is evident. Extensive bilateral pulmonary parenchymal disease is noted with diffuse infiltrates. Administration of contrast opacifies the mid to distal esophagus, which demonstrates no evidence of obstruction or extravasation of contrast. We are concerned if we need to report this as a chest x-ray or as an esophagram.