Gastroenterology Coding Alert

Question: What ICD-9 code should I bill when physician orders a patient for an ultrasound and he notes down "1.9cm hypoechoic focus in liver"?

Virginia Subscriber

Answer: You should go with 793.6 (Nonspecific [abnormal] findings on radiological and other examination of abdominal area, including retroperitoneum). Sometimes, gastroenterologists would review radiographic studies or other studies which, although abnormal, are not diagnostic and do require further studies. ICD-9 793.6 helps explain medical necessity for review of such tests or for the performance of other diagnostic studies (793.5, Nonspecific [abnormal findings] on radiological and other examination of genitourinary organs).

You can use 793.6 on your claim when the physician ends up ordering multiple studies on a patient to come up with a definitive diagnosis. Most insurance companies would like to see you use this code to track utilization of high cost radiological studies.