Radiology Coding Alert

See what's changed in the official guidelines

You should never bypass any chance to review official guidelines for proper coding. The latest ICD-9 Official Guidelines, effective Nov. 15, are now available. Here are some of the highlights.

• Pain: Do not report the new pain codes in category 338.x (Pain, not elsewhere classified) if the underlying (definitive) diagnosis is known, unless the reason for the encounter is pain control rather than management of the underlying condition, says radiology coding expert Jackie Miller, RHIA, CPC, senior coding consultant for Coding Strategies Inc. in Powder Springs, Ga. 

You can use a code from category 338 as the principal or first-listed diagnosis when the encounter is for pain control (for example, epidural steroid injection for back pain), even if the cause of the pain is known, she adds. If the cause is known, you should code it as a secondary diagnosis, Miller says.

• Pathologic fractures: Report 733.1x (Pathologic fracture) for newly diagnosed pathologic fractures and when the patient receives active treatment (such as in the emergency department or when treated by a new physician).

ICD-10 Tip

When you finally use ICD-10, you'll have a whole new set of rules. Example: With ICD-10, you could report M80.021d (Subsequent encounter for fracture with routine healing, postmenopausal osteoporosis with current pathological fracture, right humerus), says Sheri Poe Bernard, CPC, CPC-H, CPC-P, senior director of project management for Ingenix Inc.

• Acute fractures: Code traumatic fractures with acute fracture codes 800-829 while the patient is receiving active treatment (Section I. C. 17.b, page 49).

Note: The pathologic and acute fracture guidelines tell you to use the aftercare codes (V54.0, V54.1, V54.8, and V54.9) for encounters after the patient has completed active treatment of a pathologic or traumatic fracture. 

But remember, some payers will want you to continue to use the fracture codes when the patient is referred for x-rays to check fracture position or healing, Miller says. "If in doubt, check with the payer," she says.

• Radiologic exam NEC: You may report V72.5 (Radiological examination, not elsewhere classified) for routine radiology testing when the patient has no signs, symptoms, or associated diagnoses. When you code an encounter that includes a routine test and a test to evaluate a sign, symptom, or diagnosis, you should assign both V72.5 and the appropriate code for the nonroutine test (Section I. C. 18.d, page 65).

Important: "Don't assume that an x-ray is routine just because the referring physician didn't give you a diagnosis," Miller says. If you use code V72.5, the payer may make the patient financially responsible for the exam. Be sure to ask the referring physician why the exam was ordered, Miller says.

• Uncertain diagnosis: The updated guidelines remind you to use signs and symptoms codes in the office setting when the documented diagnosis is uncertain, adding the phrase in bold: "Do not code diagnoses documented as 'probable,' 'suspected,' 'questionable,' 'rule out,' or 'working diagnosis' or other similar terms indicating uncertainty. Rather, code the condition(s) to the highest degree of certainty for that encounter/visit, such as symptoms, signs, abnormal test results, or other reason for the visit" (Section IV. I, page 89).

Coding Clinic for ICD-9-CM previously instructed coders not to code diagnoses described as "consistent with," and the new instruction in the Guidelines emphasizes that you should not code unconfirmed conditions regardless of the physician's specific wording indicating that the condition is unconfirmed, Miller says.

• V code table: The latest update includes a new, more user-friendly V code table with columns showing whether each code is first listed, first or additional, additional only, or nonspecific diagnosis (page 68).

Previously you had to search through multiple lists in order to locate a specific V code, Miller says.
  
Note: You can review the "ICD-9-CM Official Guidelines for Coding and Reporting," updated Nov. 15, 2006, at www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide06.pdf.