Radiology Coding Alert

Help payers determine who pays by assigning activity codes.

After a long winter, patients love to get out and enjoy the nice weather. However, several summertime activity injuries can land patients in the imaging suite. Knowing how to properly code X-rays and computed tomography (CT) scans, as well as determining what happened at the time of the injury, can help ensure your patients’ claims get paid appropriately.

See if you can correctly code these summertime injuries.

Don’t Fall When Coding Bicycling Injuries

Scenario 1: A patient arrived at an urgent care clinic after experiencing an accident while riding their bicycle. The patient crashed and hit their head, but didn’t lose consciousness. In addition to minor scrapes and bruises, the patient had a 10 cm laceration on their scalp without any foreign bodies and was suffering from a severe headache. They presented to the clinic to have the wound closed and to check for a concussion. The physician assistant (PA) performed a physical evaluation, neurological exam, and cognitive testing. Following the tests, the PA ordered a CT scan without contrast to assess the patient’s brain and skull.

The images revealed no skull fractures, no cerebral hemorrhage, and no cerebral edema. The PA closed the patient’s head wound and applied a bandage to aid in healing. The PA diagnosed the patient with a concussion without loss of consciousness and an open laceration on the head.

Choose the codes: Codes will need to be assigned for the CT scan and repair of the patient’s laceration. Start by locating CT Scan in the AMA CPT^® code set’s index. Under CT Scan, you’ll find sections for “with contrast,” “with and without contrast,” and “without contrast.” Use the index to direct you to the possible codes. Then, review the descriptors, and select the appropriate code. In this scenario, the radiologist performed the CT scan without contrast, so they will assign 70450 (Computed tomography, head or brain; without contrast material), appending modifier 26 (Professional component) if they’re reporting only their professional services.

Next, the PA will report the wound repair. To correctly code a simple wound repair, you’ll need to know the “sum of lengths of repair,” according to the CPT^® guidelines. This patient’s scalp laceration measured 10 cm long, which leads you to select 12004 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 7.6 cm to 12.5 cm).

You’ll then turn to the ICD-10-CM codes. The PA diagnosed the patient with a concussion without loss of consciousness and an open laceration of the head. In the ICD-10-CM code set, you’ll assign S06.0X0A (Concussion without loss of consciousness, initial encounter) to report the primary diagnosis.

You’ll also need to code the open laceration of the patient’s scalp. Luckily, the code set provides a helpful reminder. “The S06.0- (Concussion) codes have a Code also note,” says Lauren Braico, CPC, CEDC, medical coder of Practical Resources LLC in Syracuse, New York. Tied to parent code S06.- (Intracranial injury), the Code also note instructs you to include applicable codes from S01.- (Open wound of head) and S02.- (Fracture of skull and facial bones) categories. The patient also experienced an open laceration of their head, which leads you to assign S01.01XA (Laceration without foreign body of scalp, initial encounter).

Help Your Arm X-ray Coding Bounce Back

Scenario 2: Parents of a 12-year-old patient brought their child to the emergency department (ED) following a fall off a trampoline, which resulted in an injury to the right forearm. The right forearm was sensitive to touch, so the physician ordered X-rays. The hospital’s radiologist captured lateral and oblique views, and the provider diagnosed the patient with a closed nondisplaced fracture of the right ulna shaft. The physician applied a short arm cast (from the patient’s elbow to their fingers), and the physician instructed the parents to follow up with the patient’s pediatrician the following week.

Assign the codes: The radiologist captured lateral and oblique views of the patient’s right forearm, which leads you to assign 73090 (Radiologic examination; forearm, 2 views). You shouldn’t select 73060 (… humerus, minimum of 2 views) for this injury since the humerus is the upper arm.

The ED physician will report the cast application. In this scenario, the physician applied a short arm cast, so the ED physician will assign 29075 (Application, cast; elbow to finger (short arm)). Depending on the payer’s preferences, you may need to append 29075 with modifier RT (Right side) to indicate the provider applied the cast to the patient’s right forearm.

In the ICD-10-CM code set, there are several code subcategories for different fractures of the ulna shaft, but you’ll notice there isn’t one for a nondisplaced fracture. In this scenario, you’ll assign a code from the S52.29- (Other fracture of shaft of ulna) subcategory and choose the appropriate 7th character. The patient was diagnosed with a closed nondisplaced fracture of the right ulna shaft, so you’ll assign S52.291A (Other fracture of shaft of right ulna, initial encounter for closed fracture) for the diagnosis.

Activity Codes Can Help Determine the Payer

Activity codes back up your claims and explain what happened when the injury occurred. “Activity codes are important to assessing injury trends across the country.

In recent decades, we have seen new codes for sports (e.g., snowboards, hang gliders, scooters, inline skates). The codes help with helmet and other safety laws and apprise parents and recreation enthusiasts of the dangers associated with their sport. These are important data collection points for federal, state, and local laws,” says Sheri Poe Bernard, CPC, CRC, CDEO, CCS-P, of Poe Bernard Consulting in Salt Lake City, Utah.

Activity codes help paint that complete clinical picture and provide greater clarity about the patient’s injury. “Activity codes also help with determining which insurance is responsible for care of the patient,” Bernard adds.

For example, in Scenario 2, since the patient’s arm fracture was a result of falling off a trampoline, you should include the activity code in case the fall occurred at a location other than the patient’s home. This is a case where the activity code could help determine which payer is responsible for payment. For Scenario 2, you’ll assign W09.8XXA (Fall on or from other playground equipment, initial encounter) and Y93.44 (Activity, trampolining).

According to ICD-10-CM Official Guidelines, Section I.C.20, “There is no national requirement for mandatory ICD-10-CM external cause code reporting.” The guideline explains that reporting codes from Chapter 20: External Causes of Morbidity is voluntary, unless the provider is bound by a state-based external cause code reporting mandate.