Enhance Your Bottom Line When Reporting Imaging Studies
Published on Fri Dec 01, 2000
Radiology coders often find themselves debating whether a particular imaging study is best described as a limited or complete procedure. Obviously, the answer has a tremendous impact on reimbursement.
There are so many gray areas when performing diagnostic exams like ultrasounds or CTs [computerized tomography], points out Michelle Juette, CPC, business services manager for Yakima Valley Radiology in Yakima, Wash. Its sometimes hard for coders to determine whether the imaging being done can truly be reported as a complete study or simply as a limited study.
For example, during a complete abdominal ultrasound (CPT 76700 , echography, abdominal, B-scan and/or real time with image documentation; complete), the technologist also views both kidneys, which are typically considered retroperitoneal organs. Should the practice bill for a limited retroperitoneal study (CPT 76775 , echography, retroperitoneal [e.g., renal, aorta, nodes], B-scan and/or real time with image documentation; limited) in addition to the complete abdominal study? Or are the kidneys considered to be included in the abdominal study?
In another example, a physician, suspecting appendicitis (540.1, acute appendicitis with peritoneal abscess), orders a focused abdominal ultrasound study of the right lower quadrant (76705, echography, abdominal, B-scan and/or real time with image documentation; limited). The radiologist finds diffuse peritoneal fluid and extends the examination to include the remainder of the abdomen. Can the practice code and bill only for the limited exam as ordered? Or may it report a complete abdominal study?
Professional radiology coders like Juette recommend the following three strategies to help bring these issues into better focus and code more accurately:
Strategy 1: Gain a clear understanding of the clinical definitions for each anatomical area studied. Several specific anatomical areas generate the majority of questions in the complete vs. limited study debate. These include the abdominal, retroperitoneal, nonobstetrical pelvic and obstetrical pelvic studies. There is a certain amount of overlap between some of these areas, where specific organs may fall into both areas, says Patti Offner, RT, with Diagnostic Imaging Inc. in Philadelphia. That creates a lot of confusion. For instance, the abdominal and retroperitoneal studies may view some of the same organs.
Both Offner and Juette say they rely heavily on definitions provided by the American College of Radiology (ACR) in its Ultrasound Coding Users Guide. These descriptions should be the starting point for any coder, explains Juette. They give a thorough description of what organs and systems are included in specific anatomical studies.
The ACR defines a complete retroperitoneal ultrasound (76770), for instance, as including images of the aorta, inferior vena cava, retroperitoneal structures and the retroperitoneal lymph nodes. The code also can include examination of urinary tract organs like the kidneys, ureter and bladder because these organs are retroperitoneal for [...]
