Radiology Coding Alert

Question: We performed an abdominal ultrasound for gastritis, which was denied by Medicare. We assigned ICD-9 535.40 (other specified gastritis) as the diagnostic code and 76700 as the radiological code (echography, abdominal, B-scan and/or real time with image documentation; complete). Has Medicare now decided that this is not an appropriate reason for an ultrasound?

Anonymous CT reader

Answer: After reviewing the medical report detailing the readers billing problem, Garnet Dunston, CPC, MPC, of Dunston Enterprises Inc. in Phoenix, AZ, noted that the report specifically states the patient has a history of burping and abdominal discomfort. The payment problem may arise from the diagnosis code assigned, she says.

Given the symptoms that are outlined in the patients report, I think this practice could have assigned either 789.00 (abdominal pain; colic: NOS, infantile; cramps, abdominal) or 787.3 (flatulence, eructation, and gas pain).

I believe I would have submitted this bill first with 789.00 because the patients discomfort has been documented. It may be possible to use a different fifth digit for diagnosis code 789.0, showing the specific location of the abdominal pain/discomfort, if known. The higher the specificity of the code, the better the likelihood of reimbursement.