Providers perform diagnostic radiology services not only to evaluate a patient’s condition, but also to follow up on progress or determine whether a treatment is working. Coding these services sometimes seems straightforward, but it’s easy — and dangerous — to get complacent about radiology coding.
Check out three tips that can help you ensure that your radiology coding skills will help you collect for diagnostic services every time.
1. Double Check All Code Options Before Reporting Codes A La Carte
Although you may be inclined to select radiology codes on an a la carte basis, it’s important to first check CPT to determine whether any combination codes exist.
For instance, suppose you read a report indicating that a doctor ordered X-rays with three views of the patient’s abdomen and one view of the chest. Some coders might be inclined to select 74021 (Radiologic examination, abdomen; 3 or more views) along with 71045 (Radiologic examination, chest; single view). However, a closer look at your CPT manual reveals that 74022 (Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect, decubitus), and a single view chest) is the better option.
Because 74022 includes “two or more” abdomen views (and you performed three) along with a single chest view, it covers everything you performed during the X-rays. In addition, it could also prevent you from upcoding accusations.
Here’s why: If you report 74021, you’ll collect about $44, while 71045 will net you another $26, totaling $77 for the two codes together. Even if the payer takes 50 percent off of 71045 for the multiple procedure reduction, you’ll still collect $57. However, you’ll bring in just $51 for the correct code 74022. Payers might accuse you of gaming the system if you report 71045 and 74021 together instead of the more accurate code, 74022.
2. Determine Whether the TC or 26 Modifiers Are Needed
When it comes to outpatient coding, most radiology procedures include both a technical and a professional component. If you perform the actual radiology procedure itself but your providers do not interpret the report, you’ll report the accurate CPT code with modifier TC (Technical component) appended. If, on the other hand, the procedure is performed elsewhere but your physician interprets it, you’ll bill the code with modifier 26 (Professional component) appended.
In radiology coding cases when your practice owns the equipment, your staff performs the procedure and your provider interprets the report, you’ll report the CPT code with no modifiers appended.
3. Avoid Rule out, Probable Diagnosis Codes
Your physician may document that they’re ordering imaging tests to rule out a particular condition, but you should never report the “rule out” diagnosis with an ICD-10-CM code. Instead, use the diagnosis code for the patient’s chief complaint when you’re handling radiology coding.
For example: Suppose a patient presents with persistent left knee pain and the doctor orders an MRI of the knee to rule out a ligament tear. Instead of reporting the ligament tear or another rule-out diagnosis on the claim, your ICD-10-CM code should be M25.562 (Pain in left knee).
It’s essential that every coder knows how CMS will be reimbursing services in 2024. Get the coding, billing and reimbursement tips you need from expert Kim Huey, MJ, CHC, CPC, CCS-P, PCS during her latest training event, Ace 2024 CMS Fee Schedule Updates: G2211, Telehealth & More. Register today!
 |
Subscribe to Healthcare Practice Advisor |
| Get actionable advice to help improve your practice’s reimbursement, compliance, and success in this weekly eNewsletter. |
|
|
|