Radiology Coding Alert

Grade your responses to the questions on page 60

See if your answers match up with the experts’ answers on this wide-ranging radiology coding quiz.

Rate Your Radiopharmaceutical Coding Skills

Answer 1: B. For 15 millicuries of technetium mebrofenin, you should report one unit of A9537 (Technetium Tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries). HCPCS replaced A9513 in 2006 with A9537.
 
The new code describes the agent by dose, which is more in line with how you purchase and use the agent, says Denise Merlino, MBA, CNMT, FSNMTS, coding adviser for the Society of Nuclear Medicine.

Bone Up on Balloon Angioplasty

Answer 2: No. The balloon angioplasty is included in the work for 33883 (Placement of proximal extension prosthesis for endovascular repair of descending thoracic aorta [e.g., aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption]; initial extension).

Determine the Proper Renal Dx Code

Answer 3: You should report a renal mass with ICD-9 593.9 (Unspecified disorder of kidney and ureter). For renal cancer, report 189.0 (Malignant neoplasm of kidney and other and unspecified urinary organs; kidney, except pelvis). A benign renal neoplasm merits 223.0 (Benign neoplasm of kidney and other urinary organs; kidney, except pelvis).
 
Remember: Choose diagnosis codes that match your documentation exactly.
 
And never decide which ICD-9 code to use based on payer coverage, says Margaret Gambill, RHIA, CCS-P, with BKD Health Care Group.

When more than one ICD-9 code is accurate and describes the patient’s condition(s), report all pertinent diagnosis codes.

Handle Hip MRIs

Answer 4: For hip MRIs, you should choose a code from 73721-73723 (Magnetic resonance [e.g., proton] imaging, any joint of lower extremity ...) because the hip is a joint, says Sandi Scott, CPC, PMCC instructor and director of audit and training for InSight Health Corp. in Lake Forest, Calif.
 
For an exam without contrast material, report 73721 (... without contrast material).

Set Your Sights on a Specimen Code

Answer 5: When a radiologist examines a tissue specimen removed during surgery, you should report 76098 (Radiological examination, surgical specimen) for the service.
 
Note: Code 76098 describes an examination of the removed specimen. You should not report the code for  follow-up imaging performed on the patient herself.
 
Remember: When both the radiologist and pathologist report the specimen x-ray interpretation, the first claim in is typically the one that gets paid.

Assign Proper Ablation Codes

Answer 6: Report the two radiofrequency endovenous ablations with codes 36475 and 36476, says Roseanne R. Wholey, president of Roseanne R. Wholey and Associates in Oakmont, Pa.:

 • 36475 -- Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated
 • +36476 -- ... second and subsequent veins treated in a single extremity, each through separate access sites (list separately in addition to code for primary procedure).
 
 Bottom line: For two veins treated in the same leg and through different access sites, report one unit of 36475 and one unit of 36476.