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Radiology Coding Alert

Take Your UGI Coding Up a Notch

Published on Sat Jan 22, 2005

Our specialists shift your knowledge from OK to expert

Avoid coding pitfalls by knowing what to watch out for and what information you really need to choose the right code.
 
Our experts read the "Dictated Report" in Test Your UGI Coding Savvy (this issue) and shared their secrets to steering clear of upper gastrointestinal coding hazards.
 
1. Watch out for bundles. The esophagus and swallowing are prominent in our clinical example, but don't waste time looking for separate codes. According to the NCCI Edits , 74220 (Radiologic examination; esophagus) is inclusive in 74241 (Radiologic examination, gastrointestinal tract, upper; with or without delayed films, with KUB) and you can't use a modifier to bypass this edit, says Stacy Gregory, RCC, CPC, charge capture and reconciliation specialist with Franciscan Health System's Imaging Support Services in Tacoma, Wash. Code 74220 is also inclusive in 74240 (... with or without delayed films, without KUB).
 
NCCI also bundles the following codes into 74240 and 74241:
 
  • CPT 74000 - Radiologic examination, abdomen; single anteroposterior view
     
  • CPT 74210 - Radiologic examination; pharynx and/or cervical esophagus.
     
    In addition, codes 74010 (Radiologic examination, abdomen; anteroposterior and additional oblique and cone views) and 74240 are bundled into 74241.
     
    2. Know when additional or alternative codes apply. NCCI may not have an edit against coding 74230 (Swallowing function, with cineradiography/videoradiography) with 74241 or 74240, but that doesn't mean you can automatically code 74230 based on the word "swallow" in the report.
     
    Gregory warns that the documentation in our example is insufficient to justify coding 74230 because the physician is "simply observing the patient swallow under fluoroscopy as an inclusive part of the UGI examination."  

    The procedure for 74230 is much more intensive than anything our documentation supports. "A separate, complete swallowing study is not being performed," Gregory says.
     
    Tip: To decipher whether your report warrants 74230, look for an order for an esophagus study along with the specific medical necessity behind it, says Cheryl Schad, BA, CPCM, CPC, owner of Schad Medical Management.
     
    "If a swallowing function study was performed with cineradiology (motion picture recording made by an attached camera) or with videoradiography (recording motion on videotape or digital disk from a TV monitor) then the code would be 74230, only," Schad says.
     
    You absolutely must be certain you have thorough documentation of these enhancements "in order for a coder to recognize them for accurate coding and for an insurance auditor to be satisfied that the variation was performed," Schad says.
     
    3. Speak Up About Documentation. If you receive a report lacking complete information, use a little tact to tell the physician that you need a more complete report. For example, for our sample report, Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and president-elect of the AAPC National Advisory Board, suggests asking:

     1. What was ordered?
     2. Did the swallowing involve contrast? Besides being helpful for your coding, this information could be crucial if the patient has a reaction.
     3. Was there separate medical necessity for a KUB?
     
    And, of course, you want to know whether the physician uses the term "spot film" interchangeably with KUB.

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