Radiology Coding Alert

Plus, boost your documentation interpretation using the bonus tip.

Keeping track of views is key to proper X-ray coding. The following tips can help you brush up on the Medicare essentials of when to add views together to find a single code, when to report multiple codes, and what to do when you have more than the “minimum” number of views.

Tip 1: Add Views From Multiple Same-Day Services

To choose the proper code, you should add all the views performed of the same site and report the most comprehensive code, says Laureen Jandroep, OTR, CPC, CPCEMS, CPC-H, a CodeRyte coding analyst and senior instructor for New Jersey-based www.CodingCertification.org. This holds true even if the patient leaves and returns to radiology on the same day, she adds.

Example: The radiologist interprets a two-view skull X-ray taken at 10:00 and later that day interprets a single-view skull X-ray taken at 11:00. You should report 70250 (Radiologic examination, skull; less than 4 views), says Jandroep.

Support: The National Correct Coding Initiative Policy Manual, Chapter 9.C.1, spells out this rule for you: “The CPT code describing the total service should be reported, even if the patient was released from the radiology suite and had to return for additional services.”

Exception: Watch for additional views or services performed because of a change in the patient’s condition or a new condition. The CCI manual confirms that “if additional films are necessary due to a change in the patient’s condition, separate reporting may be appropriate.”

Tip 2: 2 X-Ray Codes May Be Better Than 1

Although you should not report multiple CPT codes if a single CPT code exists that describes the services, be careful you don’t choose a single code that describes more views than are documented, Jandroep warns. Auditors and payers will view this move as over-coding.

Example: The patient has single-view chest and single-view abdomen X-rays.

Don’t be tempted to report 74022 (Radiologic examination, abdomen; complete acute abdomen series, including supine, erect, and/or decubitus views, single view chest) just because the descriptor includes “abdomen” and “chest.” Code 74022 requires a complete abdomen series, which the patient did not have in this case. For a single chest and single abdomen, report 71010 (Radiologic examination, chest; single view, frontal) for the chest and 74000 (Radiologic examination, abdomen; single anteroposterior view) for the abdomen.

Support: CCI manual Chapter 9.A, states that “physicians should report the HCPCS/CPT code that describes the procedure performed to the greatest specificity possible. A HCPCS/CPT code should be reported only if all services described by the code are performed.”

Tip 3: Include Additional Views in ‘Minimum’

Watch for code descriptors that include a “minimum” number of views and be sure you include all views at or above that number in that code.

Example: To report six views of the cervical spine, report 72050 (Radiologic examination, spine, cervical; minimum of 4 views), not 72050 and 72040 (… 2 or 3 views), Jandroep says. In other words, the code’s “minimum of 4 views” covers all six views. You should not combine 72050’s “4 views” and 72040’s “2 or 3 views” to cover the six views.

Support: “The CPT descriptors for many of these services refer to a ‘minimum’ number of views. If more  than the minimum number specified is necessary and no other more specific CPT code is available, only that service should be reported,” states CCI manual Chapter 9.C.1.

Bonus Tip: Keep View Definitions Close at Hand

Good documentation should include the planes, positions, and number and type of views, among other items, says Becky Zellmer, CPC, MBS, CBCS, operations supervisor for Madison, Wis.-based SVA Healthcare Services.

Consider this list suggested by Zellmer to help you better analyze the reports that cross your desk:

• Apical -- chest including apex of the lung to minimize the rib image overlapping a lung lesion

• Anteroposterior (AP) -- front to back

• Bucky -- film placed in a device that eliminates secondary radiation

• Decubitus (DEC) -- lying on side

• Odontoid -- open-mouth cervical spine view to identify joint space C1

• Oblique -- angled view

• RAO (right anterior oblique) -- right front

• RPO (right posterior oblique) -- right rear

• LAO (left anterior oblique) -- left front

• LPO (left posterior oblique) -- left rear

• Posteroanterior (PA) -- back to front

• Swimmers -- thoracic x-ray with one or both arms over head

• Stereo -- two views of a structure, one at 90 degrees to the film and second with tube angled 12 to15 degrees toward the head.