Radiology Coding Alert

Question: One of our medical practices uses N18.6 as the diagnosis on the script for a preprocedural computed tomography (CT) scan with contrast, even for patients who aren’t diagnosed with ESRD. The referring office is saying this is a generic code and it should be used for all patients prior to CT scans.

Should we be using different diagnosis codes for preprocedural CT scans?

West Virginia Subscriber

Answer: Yes, you should be using different diagnosis codes for the CT scans. The ICD-10-CM code should accurately reflect the patient’s diagnosis or the reason for the procedure. Code N18.6 (End stage renal disease) is not a generic code and is designated for a confirmed end stage renal disease (ESRD) diagnosis.

If the patient isn’t diagnosed with ESRD, then it is incorrect to use N18.6 as the reason for the encounter. You must use a code that is appropriate for the visit and shows the medical necessity for the encounter. For example, you’d assign Z01.810 (Encounter for preprocedural cardiovascular examination) if the provider is performing a cardiovascular screening prior to a procedure, Z01.811 (Encounter for preprocedural respiratory examination) if the provider is screening for respiratory issues, or Z01.818 (Encounter for other preprocedural examination) if none of the other screening ICD-10-CM codes apply.

The medical documentation in the ordering provider’s records needs to state that the patient has the condition to support the ICD-10-CM code you’re submitting. If your facility was audited, the payer will look at the ordering provider’s notes. The claim will be disallowed if the ordering provider’s records don’t show the diagnosis you submitted.