Radiology Coding Alert

The answers might surprise you

If you think coding biopsy and rib x-ray reports is a snap, you might be in for a surprise. Our readers submitted the following questions along with their potential coding solutions, and we put our experts to the test.

Take our quiz to determine whether you can determine how to code the following two scenarios:

Question 1: An ob-gyn orders a stereotactic breast biopsy for a patient with a left breast mass (ICD-9 611.72 ). The radiologist takes the patient's vital statistics and attempts to localize the abnormality. But he cannot find it, so he cancels the procedure. The practice wants to report 99202 (Office or other outpatient visit for the evaluation and management of a new patient...) but isn't sure whether to report an office visit when  the ordering physician only requested a biopsy.

Answer: "The radiologist doesn't need an order from the treating physician to bill an E/M visit," says Jackie Miller, RHIA, CPC, senior consultant at Per-Se Technologies, a medical reimbursement consulting firm in Atlanta. "However, billing for an office visit may not be the best solution in this situation."

Snag: The problem, Miller says, is that the radiologist's documentation must meet the criteria for an E/M service. "For example, in order to bill a 99202, the radiologist would need to document an expanded problem-focused history, expanded problem-focused exam, and straightforward medical decision-making. Depending upon the extent of documentation, it may not be possible to bill an E/M service."

No E/M Documentation, No E/M Code

Solution: "If the radiologist performed a diagnostic mammogram and canceled the biopsy (before he prepared the surgical field or opened any supplies) because the mammogram showed no abnormality, the practice should report the mammogram only (76090-76091)," Miller says. "If the radiologist performed and documented a history and physical, and the documentation meets criteria for an E/M service, he could bill an office or other outpatient visit."

But if the radiologist started the biopsy procedure (which might include opening surgical supplies or preparing the surgical field) and had to cancel it, you should report the appropriate breast biopsy code (19100-19103) with modifier -53 (Discontinued procedure) appended, Miller says.

Some coders question whether they can report the biopsy that the requesting physician ordered even though they didn't perform it, but you can as long as you append modifier -53, Miller says.

"If the physician starts a surgical or diagnostic procedure but has to discontinue it due to extenuating circumstances, the CPT Codes tells you to report the attempted procedure with modifier -53," Miller says.  "Typically, when the payer receives a claim with this modifier, they will request a copy of the report to determine the extent of the procedure that you actually performed, and reduce your pay accordingly."

Remember, however, that you should not append modifier -53 unless the physician actually started the biopsy. If the physician or patient cancels the procedure before starting, you should not report the CPT code for the planned procedure.

"In this situation," Miller says, "it would be more appropriate to report an E/M code for the encounter, provided that the physician's documentation is sufficient."

Document X-Ray View Types, Not Just Quantity

Question 2: A physician orders a complete acute abdomen x-ray series. The radiology technologist shoots and documents four abdominal views, so the coder reports 74022 (Radiologic examination, abdomen; complete acute abdomen series, including supine, erect, and/or decubitus views, single view chest). Is this the correct code?

Answer: The correct code is impossible to determine, says Cheryl A. Schad, BA, CPCM, CPC, owner of Schad Medical Management, a medical reimbursement consulting firm in New Jersey. "They may have taken four views, but for all we know, they may all have been AP views of the abdomen," Schad says. 

Even though radiology technologists should always document the number and type of radiologic views they take, it's the type of views -- not just the number -- that will help you determine your code.

"If you only dictate four abdomen views, the highest code you can assign is 74000 (Radiologic examination, abdomen; single anteroposterior view)," Schad says. "To report 74022, you have to at least document a supine, erect and/or decubitus view, and a single view of the chest." Without documenting these views, the code must default to 74000.

Poor Documentation Can Cost You $18 Per Study

Reality: If you perform a complete acute abdomen series, but you only document a four-view abdomen, you forfeit about $18 -- the difference in Medicare's reimbursement between 74000 and 74020.