Radiology Coding Alert

Ensuring proper diagnosis coding for dual energy x-ray absorptiometry (DEXA) scans can be difficult enough when you see osteoporosis patients, but you must be even more precise when reporting DEXAs on male patients. Always remember two things - specificity and medical necessity - to decrease your denials.

Diagnosis codes tell payers why a radiologist performed a scan, and carriers will deny payment if the ICD-9 codes are not specific enough. You can ensure you are coding to the highest level of specificity and showing proper medical necessity by following a three-step coding and assessment process:

1. Gather Complete Information. The physician's written notes may not have enough information for you to code correctly. To make sure you have the details you need, consider using an encounter form that lists the common diagnoses along with a clear indicator when more specificity is needed. This will help educate the physician regarding which ICD-9 Codes require more information. For example, you can use a line after the code to indicate clearly that you require more digits (for example, 805.__).

2. Use the Code With the Highest Specificity. No matter how well the physician communicates the patient data, you must ensure that you have the right code and that you carry it to the highest digit possible. Note any caution or warning symbols in the ICD-9 Codes (some color-coded books use yellow for nonspecific codes and red for those with missing digits), and know your DEXA scan terminology well.

The simple rule: Assign three-digit category codes only if there are no four-digit subcategory codes within that code category, assign four-digit codes only if there are no five-digit subclassifications for that category, and assign the five-digit codes when they are available.

3. Run Frequent Reports. About every two months, use your billing software to generate a report of the most frequent diagnosis codes and CPT Codes that each physician used. Carefully review the reports, noting which nonspecific codes the physicians used and how often. Report this information to the physicians and keep track of each report to benchmark progress and trends.