Radiology Coding Alert

Radiology coders must keep abreast of coding conventions for a diverse range of subspecialties from diagnostic imaging, to interventional, to nuclear medicine, to radiation therapy. To be successful, you must educate yourself about correct coding and stay alert to changes that affect reporting and, ultimately, reimbursement. The surest way to accomplish this is to keep resources on hand to help answer questions and select appropriate codes.

General Radiology Resources

"There are a number of references that I consider 'must haves,' no matter what area of radiology a coder works in," says Donna Richmond, RCC, CPC, radiology coding specialist with Acadiana Computer Systems Inc., a medical billing management company based in Lafayette, La., that serves more than 200 radiologists, pathologists and anesthesiologists.

Her list includes current editions of the CPT Codes , ICD-9 Codes and HCPCS manual . "Having these resources available is not enough, however," she says. "A lot of coders have not familiarized themselves with how to use these manuals and often don't refer to them when trying to determine valid codes to assign. It's important to keep them at your fingertips and use them religiously."

Books: General

A medical dictionary such as Stedman's Medical Dictionary, Dorland's Medical Dictionary or Taber's Cyclopedic Medical Dictionary provides descriptive definitions about conditions, procedures, tests, etc. This information can greatly assist coders as they review a radiologist's notes. A book of common medical abbreviations is also invaluable.

A general anatomy reference like Gray's Anatomy or Netter's Atlas of Human Anatomy can also clarify a physician's notes and assist in assigning the correct code to match a clinical or procedural description.

AMA Principles of Coding and CPT Companion provide a solid foundation for understanding basic coding.

AMA CPT Changes 2002: An Insider's View provides easy-to-understand explanations of revisions, additions and deletions to the 2002 codes.

The Medicare Providers Manual or Medicare Carriers Manual explains the rules that govern coding for Medicare beneficiaries.

Medicare's RBRVS: The Physician's Guide provides information about the valuation of the various codes and the reimbursement levels physicians may expect to receive.

Books: Radiology-Specific

Ultrasound Coding User's Guide, published by the American College of Radiology (ACR), provides thorough explanations and definitions to clarify coding questions.

Coding Guide for Radiology and the Radiology CROWN Seminar series offered by Coding Strategies Inc. (877-626-3464 to order or register). These resources provide a clinical explanation of the services described in radiology codes, as well as definitions and special considerations that affect code assignment.

The Radiology Correct Coding Initiative handbook, published by Medlearn, provides comprehensive information about the principles of coding.

Periodicals: General

CPT Assistant is a monthly AMA publication that provides in-depth explanations in the use of specific codes and clarifies the intended use of various codes. "This is absolutely necessary," Richmond says, "because the AMA developed the CPT codes. CPT Assistant is its vehicle for explaining how the codes should be used."


The Federal Register contains information about the relative value units (RVU) of codes, as well as bundling information. It also covers proposed changes and commentary relative to draft coding policies.

Periodicals: Radiology-Specific

Radiology Coding Alert newsletter. "This monthly publication is extremely helpful," notes Michelle Juette, CPC, RCC, business services manager for Yakima Valley Radiology in Yakima, Wash., "because it covers everyday examples and provides strategies applicable in true-to-life scenarios. The publisher, The Coding Institute, also provides regular teleconferences that cover a wide variety of radiology coding topics."

The ACR Bulletin and the RBMA Bulletin. "Articles on correct coding appear first in the ACR publication and then in the Radiology Business Management Association (RBMA) newsletter," Richmond says. "They are very useful, and the information can be applied in day-to-day coding."

Electronic: General

The CMS Web site at www.cms.hhs.gov. "This Web site is a terrific resource for coders," Richmond says. "It provides information about any changes affecting Medicare reimbursement that are coming down the road. This is where coders can keep up-to-date on program memoranda, transmittals and the Medicare Carriers Manual."

A CMS Web site dedicated to local medical review policies (LMRPs) for carriers and fiscal intermediaries: www.lmrp.net. This site allows you to investigate the payment policies of local carriers for specific codes and procedures.

The Society for Clinical Coding at www.sccoding.org provides general information about coding in a variety of specialties.

AMA CPT Assistant software and Code Manager software help radiology practices keep up-to-date with coding rules and ensure codes are assigned correctly.

A CD-ROM copy of the quarterly Correct Coding Initiative (CCI) Edits allows practices to keep abreast of codes that may be reported in conjunction with others, and those that are considered components of more comprehensive codes.

Electronic: Radiology-Specific

The Coding Institute's Coding 911 discussion group for radiology at www.coding911.com. "This comes in very handy because you can post your questions and benefit from the input of other professional coders," Juette says.

The site serving the Radiology Business Management Association (RBMA) at www.rbma.org and its discussion group (for members only), which is monitored by reputable radiology coding experts.

Many experts refer coders to the Web site serving the Society of Nuclear Medicine at www.snm.org to learn more about codes that apply specifically to nuclear radiology.

Other sites that include both general radiology and coding-specific information include the site serving the American Healthcare Radiology Administrators at www.ahraonline.org, the American College of Radiology site at www.acr.org, and the Aunt Minnie Web site at www.auntminnie.com.

Interventional Radiology (I/R) Resources

Interventional Radiology Coding Users' Guide, published by the Society of Cardiovascular and Interven-tional Radiology (SCVIR). "This provides a lot of how-to information in this area, which can be very challenging," Richmond says.

Interventional Radiology Coder, published by MedLearn. "This features a lot of easy charts that are helpful after coders learn the basics of IR coding," Richmond says.

Interventional Radiology Coding Seminars, presented by coding professional Walt Blackham through RBMA. The seminars focus on the basic principles that guide IR coding and apply them to specific case studies.

Introduction to Interventional Radiology and the Interventional Radiology CROWN Seminar series offered by Coding Strategies Inc. This handbook and conference series introduces coders to the specialty and provides information about how to apply the coding principles in practice.

Radiation Therapy

The Radiation Oncology Coding Users' Guide, published jointly by the ACR and the American Society of Therapeutic Radiology and Oncology (ASTRO), provides clinical definitions and guidance about the proper use of radiation therapy codes. Another frequently mentioned resource in this discipline is the Coding Guide for Radiation Oncology and the Radiation Oncology CROWN Seminar series, offered by Coding Strategies Inc.

In addition to these specific resources, you should establish a good relationship and open communication with a radiologist in your practice. Physicians are tremendous resources when you are learning about specific procedures and studies conducted, and can often help determine which codes are best reported.

Note: Radiology Coding Alert does not necessarily endorse any of the other resources noted.