Radiology Coding Alert

Question: We are reporting for the professional services of our radiologist and need help coding the diagnosis component. Should we report the ICD-9 code for why the radiological investigation was undertaken or for what was diagnosed in the radiological examination?

Should the technical component always be billed with the exact same diagnosis as the professional component? We are a billing company and bill the professional side with the results of the test. The facility is coding for the technical component, and we are not sure if different diagnosis for the technical and professional components will be acceptable.

Alaska Subscriber

Answer: You select the appropriate diagnosis code depending upon the timing of your billing. For example, if you are reporting the X-ray ordered by your physician in a patient who presents with a cough, you report the ICD-9 code 786.2 (Cough). If you wait until the results are in and the patient is then diagnosed pneumonia, you can report 486 (Pneumonia organism unspecified).

You may be reporting for only the professional services of your physician. The diagnoses of both the professional and technical components should preferably be the same. However, due to billing before the arrival of result, there might be a difference in diagnosis codes, as you have rightly pointed out. While this is not a wrong practice on the facility’s part, whenever you have the results of the radiology service, those results would have precedence over the signs and symptoms when issuing diagnosis codes. Since you bill the services with the diagnosis codes from the results of the service, you should not have a problem going through with the claims once you start sending the carriers the results (medical records) according to the appended diagnosis codes.

Coding signs and symptoms while you have the final diagnosis at hand would not be a desirable practice. Other than the option you have suggested, you should coordinate with the facility to also code the final result, although in that case, they might need to put in a certain wait period to bill out their claims.

According to the ICD-9-CM Official Guidelines for Coding and Reporting , the coding rule for coding signs and symptoms states: “Codes that describe symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes only when a related definitive diagnosis has not been established (confirmed) by the provider.”

In your case, you have a definitive diagnosis as established by the result of the test. Thus, it follows that coding signs and symptoms when you have the final diagnosis established by the test itself for which you are issuing diagnoses, would not be a desirable practice.