Primary Care Coding Alert

See what the guidelines advise

You should never bypass any chance to review official guidelines for proper coding. The latest ICD-9 Official Guidelines, which were effective Nov. 15, include some new advice for family medicine coders who submit x-ray claims. We-ve got the highlights that can help keep your x-ray payment rolling in.

Keep the following tips near your x-ray code list so you can refer to it whenever you-ve got a radiology claim to submit:

- Pain: Do not report the new pain codes in category 338.x (Pain, not elsewhere classified) if the underlying (definitive) diagnosis is known, unless the reason for the encounter is pain control rather than management of the underlying condition, says Jackie Miller, RHIA, CPC, senior coding consultant for Coding Strategies Inc. in Powder Springs, Ga. 

You can use a code from category 338.x as the principal or first-listed diagnosis when the encounter is for pain control (for example, epidural steroid injection for back pain), even if the cause of the pain is known, she adds. If the cause is known, you should code it as a secondary diagnosis, Miller says.

- Pathologic fractures: Report 733.1x (Pathologic fracture) for newly diagnosed pathologic fractures and when the patient receives active treatment (such as in the emergency department or when treated by a new doctor).

- Acute fractures: Code traumatic fractures with acute fracture codes 800-829 while the patient is receiving active treatment (Section I. C. 17.b, page 49).

Note: The fracture guidelines tell you to use the aftercare codes (V54.0, V54.1, V54.8 and V54.9) for encounters after the patient has completed active treatment of a pathologic or traumatic fracture. 

But remember, some payers will want you to continue to use the fracture codes when the patient requires x-rays to check fracture position or healing, Miller says. -If in doubt, check with the payer,- she says.

- Radiologic exam NEC: You may report V72.5 (Radiological examination, not elsewhere classified) for routine radiology testing when the patient has no signs, symptoms or associated diagnoses. When you code an encounter that includes a routine test and a test to evaluate a sign, symptom or diagnosis, you should assign both V72.5 and the appropriate code for the nonroutine test (Section I. C. 18.d, page 65).

Important: Don't assume that an x-ray is routine just because the physician didn't note a diagnosis before he interpreted the films. If you use code V72.5, the payer may make the patient financially responsible for the exam. Be sure to ask the physician why he ordered the exam, Miller says.

- Uncertain diagnosis: The updated guidelines remind you to use signs and symptoms codes in the office setting when the documented diagnosis is uncertain, adding the phrase in bold: -Do not code diagnoses documented as -probable,- -suspected,- -questionable,- -rule out- or -working diagnosis- or other similar terms indicating uncertainty. Rather, code the condition(s) to the highest degree of certainty for that encounter/visit, such as symptoms, signs, abnormal test results, or other reason for the visit- (Section IV. I, page 89).

Coding Clinic for ICD-9-CM previously instructed coders not to code diagnoses described as -consistent with,- and the new instruction in the Guidelines emphasizes that you should not code unconfirmed conditions regardless of the physician's specific wording indicating that the condition is unconfirmed, Miller says.

- V code table: The latest update includes a new, moreuser-friendly V code table with columns showing whether each code is first listed, first or additional, additional only, or nonspecific diagnosis (page 68). -This table is going to make it a lot easier to read through the V codes,- says Heather Corcoran, coding manager at CGH Billing in Louisville, Ky.

Previously you had to search through multiple lists in order to locate a specific V code, Miller says.
 
Note: You can review the -ICD-9-CM Official Guidelines for Coding and Reporting,- updated Nov. 15, 2006, at www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide06.pdf.