Radiology Coding Alert

Question: What diagnosis code should I use for a routine x-ray if the patient doesn't have any documented signs, symptoms or other diagnoses related to the test?

Texas Subscriber

Answer: For a true "routine" exam, the official ICD-9 guidelines say to assign V72.5 (Radiological examination, not elsewhere classified) when the patient has no signs, symptoms or associated diagnoses. If you use this code on the claim, however, Medicare will treat it as a non-covered, non-medically necessary service that the patient is financially responsible for. This can result in an unhappy patient who may take his complaints back to his treating physician.

The best solution to this problem is to nip it in the bud by not performing the exam without knowing the reason the physician ordered it. Getting the ordering diagnosis is important not only for reimbursement but also for patient care so that the interpreting physician knows what the clinical question is (what the treating physician is looking for). Explain to your referring physician's office staff that you need this information before you can schedule the exam, and then make sure your scheduling staff adhere to this policy.

Tip: Very few exams are really "routine." Usually the patient has signs or symptoms, has past history of disease, is scheduled for surgery or is being screened for a specific condition. You can assign specific ICD-9 codes in all of these situations.