Radiology Coding Alert

Take note of this especially important new add-on code.

As the new year begins, you’re going to find yourself coding within a particular window of time where date of service (DOS) becomes especially important. That’s because, as the new CPT^® changes come into effect, you’re going to have to make a seamless transition from 2019 to the vast number of radiological changes in store for 2020.

Some of the most important new, revised, and deleted codes fall under the gastrointestinal (GI) radiography code set. To help make the transition to the new year as smooth as possible, you’re going to tackle a few coding examples of GI codes that will be impacted with the 2020 CPT^® changes.

Kick off the new year on a high note by working through these three example dictation reports.

Find Right GI Code With a Few Steps

Example: Scout radiograph of the abdomen was obtained. Patient was then given effervescent granules to consume. The patient was then asked to drink liquid barium solution while the esophagus stomach and duodenal sweep were assessed under active fluoroscopy. The patient was then given a barium meal and serial radiography of the abdomen was obtained.

When working on a GI radiography case study, it’s good practice to sort out the details that you do and do not have available. First, you can easily identify two contrast agents. The first is documented as the administration of the effervescent granules. The second contrast agent is the administration of the liquid barium solution. Next, you want to identify the level of the GI tract that the radiologist reaches. In this case, the radiologist documents imaging up to the point of the duodenum. Since the radiologist does not document the entirety of the small intestine, you may not include it when making a coding determination.

Interestingly enough, the 2019 and 2020 version of CPT^® codes are the same, but the code description changes for 2020 make the task of allocating the correct code much easier. In this example, the following CPT^® code will encompass the entirety of the provider’s services:

• 74246 (Radiologic examination, upper gastrointestinal tract, including scout abdominal radiograph(s) and delayed image(s), when performed; double-contrast (eg, high-density barium and effervescent agent) study, including glucagon, when administered).

Fortunately for the coder working on this example, the AMA has done away with references to kidneys, ureter, and bladder (KUB) imaging, and instead replaced it with “scout abdominal radiograph(s).” In years prior, the coder would have had to either request an addendum to document KUB or choose the code that does not include any abdominal radiographic imaging.

Incorporate This Add-On Code Into the Mix

Example: The preliminary abdominal radiograph demonstrates abundant colonic fecal loading especially in the proximal right colon. After ingestion of an oral effervescent agent and barium, multiple images of the esophagus, stomach, duodenum and small bowel are performed. The small bowel series demonstrates normal mucosal pattern of the jejunum and ileum.

In this scenario, you’re looking at replacing the following code that’s been deleted in 2020:

• 74249 (Radiological examination, gastrointestinal tract, upper, air contrast, with specific high-density barium, effervescent agent, with or without glucagon; with small intestine follow-through).

To simplify things, the CPT^® manual now includes an add-on code to report alongside your primary CPT^® code when the physician documents a small bowel (or small intestine) follow-through series. Since this example also includes the use of double contrast, the primary code you will report is 74246. You’ll also include code +74248 (Radiologic small intestine follow-through study, including multiple serial images (List separately in addition to code for primary procedure for upper GI radiologic examination)).

Coder’s note: “Keep in mind that the code description only allows for this service to be submitted alongside upper GI radiologic services,” says Lindsay Della Vella, COC, medical coding auditor at Precision Healthcare Management in Media, Pennsylvania. “This includes codes 74240 [Radiologic examination, upper gastrointestinal tract, including scout abdominal radiograph(s) and delayed image(s), when performed; single-contrast (eg, barium) study] and 74246,” Della Vella adds. 

Discern Between Single, Double Contrast Studies

Example: After ingestion of barium, images of the esophagus, stomach, and duodenum are performed. Following this, after further ingestion of barium, small bowel series is obtained. A scout KUB does not reveal any evidence of abnormal pathology.

You’re now working with an example involving the administration of one form of contrast: barium. You’ve got enough documentation to support imaging of the upper GI tract and a small bowel series. Furthermore, you’ve got documentation of a KUB. With the addition of the KUB, coding of this procedure before 2020 would have resulted in the following deleted code:

• 74241 (Radiologic examination, gastrointestinal tract, upper; with or without delayed images, with KUB).

However, with the deletion of this code and subsequent changes to rules surrounding documentation of KUB, your coding determinations will be different this year. You’ll report the following two codes:

• 74240
• +74248.