Avoid Time-consuming Denial Follow-up:
Know Your Carrier's Requirements for Preoperative Chest X-rays
Published on Wed Sep 01, 1999
Radiology coders nationwide are reporting a wide range of problems with the denial of payment for preoperative chest x-rays (71010, single view or 71020, two views). This is mostly due to unacceptable diagnosis coding (ICD-9-CM Codes ) to justify the medical necessity of the examination. Unchecked rises in denials for pre-op chest films can cause heavy demands for follow-up, recoding, rebilling, higher write-offs, and significant risk exposure for coding noncompliance. Practices may be underestimating the significance of hidden losses from these denials.
To maximize appropriate payment for preoperative chest x-rays, develop a coding strategy based on answers to the following four questions:
1. How Big is the Problem of Denials for your Practice?
The challenge of payer denials for routine preoperative chest x-rays can be described with a common scenario familiar to many radiology coders: Surgeons refer just about every patient for a chest x-ray prior to surgery, taking for granted that it is a routine standard of care. Thus, the order for the pre-op chest x-ray often fails to include sufficient information for the radiology practice to establish the appropriate reason for the examination.
Faced with a large number of chest x-rays to code (all after the fact), the radiology coder may have a tendency to simply select a default ICD-9 Code , such as V72.81 (preoperative cardiovascular examination) or the safer default code V72.82 (preoperative respiratory examination). The claims are submitted to payers, and any problems are left to be dealt with as denials occur on a case-by-case basis.
Sometimes use of a default V code works and the claim gets paid. For example, in some states (such as Tennessee and Georgia), the local Medicare carrier was denying claims using V codes, but now instructs coders simply to use one of the default V codes V72.81 to V72.83, assuming the surgeons medical record for the patient has the necessary indications to justify preoperative chest films. However, this practice of using default V codes produces a pattern that payers may interpret as indiscriminate use of preoperative chest x-ray, which could lead to payment denials as well as a higher risk of a coding audit. For example, Jane Smith, practice manager, and members of the staff at Gainesville Radiology in Georgia, report that the same V codes that get payment from Medicare are regularly denied when a pre-op chest x-ray is submitted to Medicaid, Champus and some commercial payers.
Furthermore, Susan Callaway-Stradley, CPC, CCSP, an independent coding consultant in Augusta, GA, and the American Academy of Professional Coders 1998 Coder of the Year, says that even if such claims are [...]
