Diagnostic imaging procedures such as x-rays, computer tomography (CT) scans, and Magnetic Resonance Imaging (MRI) have to be reported using the right codes on medical claims. Medical coding guidelines for all specialties including radiology are constantly updated and it is critical for radiology medical billing companies as well as practices to keep in pace with these updates. The correct procedure codes and modifiers are needed for insurers to accept radiology medical claims and provide the correct reimbursement.
Common radiology coding errors are those related to eligibility checks, referrals, and dictation errors. In rare cases, such as if a patient fails to complete the test, clear documentation in the report is crucial to describe the incomplete procedure which would help to receive the reimbursement. To ensure reimbursement, it is critical for the radiology practice to check whether the patient is covered for the particular procedure, whether he/she has run out of benefits or not, and whether the insurance has expired.
Reducing errors when filling out medical claims can result in improved compliance and reduced audit risk for your practice. Before starting the medical coding for radiology reports, check whether the report is complete with heading, number of views or sequences, clinical indications, body or findings of report, impression or conclusion, physician signature and diagnostic studies.
Radiology Coding Tips
- Check for the correct number of views on the report. Radiology dictations often do not include the correct number of views. Coders have to count the number of views and select the corresponding CPT® code. It is critical that the number of views claimed meets the basic requirements of the CPT® code reported. However, to describe those views in the exam, medical coders should be familiar with the abbreviations and terminology used. For instance, in a knee exam even if the radiologist dictates only anteroposterior, lateral, and oblique views on a knee, the coder must be skilled enough to realize that the radiologist took both left and right oblique views, making it a four-view study.
- When reporting a complete abdominal ultrasound using CPT code 76700, make sure that the physician’s report indicates all areas such as – liver, gallbladder, common bile duct, pancreas, spleen, kidneys, upper abdominal aorta, and inferior vena cava. If all these areas are not documented, use the code for limited abdominal ultrasound – CPT 76705.
- Remember that for using HCPCS code G0297 which is “Low dose CT scan (LDCT) for lung cancer screening,” patients should meet certain criteria such as – should be within 55 to 77 years of age, have no signs of lung cancer, have a 30-pack year or greater history of tobacco smoking, are current smokers, or have quit within the last 15 years.
- While reporting mammogram for undiagnosed mass or nodule, use the appropriate code to indicate the location, by breast and quadrant, of the mass or nodule. While ICD-10 unspecified codes such as “N63.0”, “N63.10” or “N63.20” are getting denied by carriers, it is recommended to use codes such as
- N63.11 unspecified lump in the right breast, upper outer quadrant
- N63.14 unspecified lump in the right breast, lower inner quadrant
- N63.21 unspecified lump in the left breast, upper outer quadrant
- N63.24 unspecified lump in the left breast, lower inner quadrant
- For infant x-rays, most insurance carriers are denying CPT codes 73592 and 73092 for children over the age of 1. These codes do not indicate specific ages. To avoid denials, providers must consider the age of the patient. If the patient is one year or older, it is important for providers to order, explicitly document and ensure that the acquired images effectively show the anatomy.
- Never code conditions listed as “Rule out”, “Possible”, “Probable”, or “Suspected”, unless they are proven to exist. Also, if the radiology exam is done because of pain, trauma or swelling, state the location with the right code.
- Check whether the radiology exam you are coding has a Local Coverage Determination (LCD) or a National Coverage Determination (NCD). While the CMS has developed NCDs for Medicare coverage of most services and supplies, for services without an NCD, Medicare administrative contractors have developed their own LCDs. Coders should make sure to review national and local policies and take care that the ICD-10 code selected is listed for the particular exam or procedure they are billing.
- Include additional modifiers if needed. Radiology procedures include both technical and professional components, which can be documented in claims such as modifier 26 for professional component, and modifier TC for technical component. Coders should check the current National Correct Coding Initiative (NCCI) edits to decide whether a modifier is necessary. Common modifiers include:
- Modifiers LT Left side and RT Right side to indicate laterality
- Modifier 59 Distinct procedural service (or X(EPSU) modifiers)
- Modifiers 76 Repeat procedure by same physician and modifier 77 Repeat procedure by another physician
- Modifier 50 Bilateral procedure
- Note if there is a contrast or not. Based on the CPT coding guidelines for Radiology, the contrast is administered by any of the following types of injection – Intravascular (into a vein or artery), Intra-articular (into a joint) or Intrathecal (into the spine). Make sure to code MRI and CT exams with contrast, without contrast, or with and without contrast. Also, do not count Oral/Rectal Administration as contrast.
Consider radiology medical coding services offered by AAPC-certified radiology coding specialists, to reduce coding errors and thus improve your practice revenue with appropriate reimbursement.