Radiology Coding Alert

As a radiology coder, you can expect to see medical reports where the radiologist is asked to check if the patient’s cancer has spread to other parts of the body. Are you prepared to correctly handle these reports when they enter your workflow?

Inspect the following radiology report and see if you can identify the correct codes for the encounter.

Dive Into the Diagnostic Radiology Report

Below is a radiology report from an osseous survey procedure. The patient’s oncologist referred the patient to the radiology clinic to check for possible metastasis of the already diagnosed left kidney cancer.

Date: January 4, 2024

Examination: X-ray osseous survey.

History: 45-year-old with left kidney cancer. Diagnostic radiographic imaging was ordered to evaluate for possible metastasis to the patient’s bones.

Reason: Suspected bone metastasis.

Technique: After properly positioning the patient, the patient’s entire skeletal system was examined using radiographic imaging. We started the examination at the skull, proceeded to the spine, chest, pelvis, and finally the upper and lower extremities. Multiple views were captured of all body structures to ensure comprehensive evaluation of the skeletal system.

Findings: Images revealed multiple osteoblastic and osteolytic lesions located in several different body structures, which include the spine, pelvis, and femur. This is consistent with metastatic disease. No dislocations or fractures were noted.

Impression: The survey findings are consistent with the clinician’s suspicion of bone metastasis. The lesions’ characteristics and distribution suggest a widespread metastatic process.

Now that you’ve reviewed the radiology report, your next step will be to determine the correct CPT^® and diagnosis codes to assign for your report.

Locate the Right Osseous Survey Code

Start with the CPT^® code set to report this encounter. Based on the radiology report, you’ll assign one procedure code for the radiologist’s service. The report lists an X-ray osseous survey as the examination, and the CPT^® code set includes three osseous survey codes:

• 77074 (Radiologic examination, osseous survey; limited (eg, for metastases))
• 77075 (… complete (axial and appendicular skeleton))
• 77076 (Radiologic examination, osseous survey, infant)

You’ll eliminate 77076 immediately from your search since the patient was 45 years old and 77076 is reserved for infants.

This leaves 77074 and 77075 as your osseous survey code options. These codes differ in how extensive of an examination is performed. “A complete osseous survey (77075) covers the entire axial and appendicular skeleton, while the limited osseous survey (77074) is limited to a particular location, such as only the axial skeleton, only appendicular skeleton, or an area of metastases,” says Taylor Berrena, COC, CPC, CPCO, CPB, CPMA, CPPM, CRC, CEMC, CFPC, CHONC, coder III of MD Anderson Cancer Center at Cooper in Yorktown, Virginia.

When you review the technique section of the radiology report, you’ll notice that the radiologist examined the “entire skeletal system.” This indicates a complete osseous survey, so you’ll assign 77075 to report the procedure.

Confirm the Cancer Code Sequencing

Next, you’ll turn to the ICD-10-CM code set to locate the correct diagnosis codes. The patient’s referring provider previously diagnosed the patient with left kidney cancer and the radiologist found that the cancer had metastasized to the patient’s spine, pelvis, and femur.

You’ll need the following two ICD-10-CM codes to report the encounter:

• C64.2 (Malignant neoplasm of left kidney, except renal pelvis)
• C79.51 (Secondary malignant neoplasm of bone)

However, you need to make sure you sequence the codes correctly. To do that, review the radiology report to determine which malignancy code to list first.

“With the left kidney cancer still currently active or being treated, the code sequencing depends on whether treatment is directed towards the primary or secondary malignancy,” Berrena says.

The ICD-10-CM Official Guidelines, section I.C.2.a, instruct you to use the primary malignancy as the first-listed diagnosis if the malignancy is the main reason for the encounter and “treatment is directed at the primary site.” On the other hand, section I.C.2.b states “When a patient is admitted because of a primary neoplasm with metastasis and treatment is directed toward the secondary site only, the secondary neoplasm is designated as the principal diagnosis even though the primary malignancy is still present.”

The patient presented to the radiology practice for suspicion of kidney neoplasm metastasis, which the radiologist confirmed in the findings and impression. You’ll assign C79.51 as the principal diagnosis code and C64.2 as the secondary diagnosis code based on the information documented in the radiology report and ICD-10-CM Official Guidelines, section I.C.2.b.

Wrap up Your Claim

How did you do? Below is a summary of the codes for this encounter.

CPT^®: 77075

ICD-10-CM: C79.51, C64.2