# Radiology Coding Question



## mafic13 (Nov 16, 2007)

One of our clients is going to start doing radiology in their office. Radiology is fairly new to me. The question I have is on how to bill an initial radiology service? what I mean by that is say a gentleman comes in for his initial visit with our physician because he is having lower back pain so prior to him being seen the physician we do a 72110. Do we use l-spine pain as the diagnosis since the service is being done prior to the physician seeing him? Do we use what the physician diagnosis him with after he has seen him and reveiwed the x-ray? Or do we make are diagnosis based on what the radiologists interpretation of the x-ray is?

Any help anyone can give on this would be appreciated. If you know of any good resources for radiology billing that would be great also.


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## kevbshields (Nov 16, 2007)

The first thing I'd recommend is printing off and becoming familiar with the Practice Standards as stated on www.acr.org (American College of Radiology).

Even if your physician is not a Radiologist, he/she will be held to many of the documentation, report, etc standards mentioned in those documents.

As for the diagnoses used for Radiology services, that depends mostly on the formal order for the service.  I doubt that will be much of a case if the docs are doing them "in-house".  Basically, the diagnoses are coded as follows (this is consistent with ICD OP Reporting Guidelines and CMS requirements/recommendations):

1.)  Any finding on the Radiology report would be reported for the radiology service--this may or may not include incidental findings on those reports (which would be reported secondarily).

2.)  If the X-ray is normal, then the stated reason for the exam/indication/history code would be reported; this is frequently a symptom (e.g., pain, etc).  

3.)  If there is a normal impression, no history, no indication, and so on, I'd use the diagnoses associated with the office visit of the ordering physician--in this case, they'd theoretically be one and the same provider.

If I were you, I'd also clearly establish whether or not the provider planned to have a Radiologist render a formal report on these films.  If the physician (him/herself) is providing interp., then you're billing a global.

Well, hope this at least gives you a strong start.  If you need any further recommendations for resources, just let me know.

Good luck.


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## donnajrichmond (Dec 3, 2007)

*Radiology coding*

The 1st questions is not how to code it, but should it be. 
Who ordered it?  If the doctor hasn't seen the patient, how does anyone know that an x-ray is appropriate?  If audited - where is the order for this exam? 
Remember, Medicare (and most, if not all other providers) do not allow protocol exams - each exam must be specifically ordered for a particular patient based on  medical necessity.   (I've had this happen, the clinic protocol said that xrays of the ankle should be done based on my history.  When I saw the doctor, he said that if anybody had asked him, he wouldn't have ordered the x-rays)

Once you decide to code - use the official guidelines for coding of physician exams. 
Here's medicare's take and examples
http://www.cms.hhs.gov/manuals/downloads/clm104c23.pdf


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## keevans (Feb 14, 2008)

mafic13 said:


> One of our clients is going to start doing radiology in their office. Radiology is fairly new to me. The question I have is on how to bill an initial radiology service? what I mean by that is say a gentleman comes in for his initial visit with our physician because he is having lower back pain so prior to him being seen the physician we do a 72110. Do we use l-spine pain as the diagnosis since the service is being done prior to the physician seeing him? Do we use what the physician diagnosis him with after he has seen him and reveiwed the x-ray? Or do we make are diagnosis based on what the radiologists interpretation of the x-ray is?
> 
> Any help anyone can give on this would be appreciated. If you know of any good resources for radiology billing that would be great also.



In our office the physician looks at xrays before the coding is done and we code by results of xray if there is no definite dx but rule out we use the back pain, hip pain etc for xray diagnosis. If you wait for the radiology interpretation you could have some logistic problems as far as changing codes and tracking down invoices unless you get an immediate read which normally does not happen in my experience.


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