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Radiology Coding Guidelines and Best Practices

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Updated Radiology Coding Guidelines For 2018

Radiology is a medical specialty that uses techniques such as X-ray, Computed Tomography (CT), CT Angiography (CTA), Magnetic Resonance Imaging (MRI), MR Angiography (MRA), Ultrasound, Nuclear Medicine, and Positron Emission Tomography (PET) scans to diagnose as well as treat diseases or health conditions. Seeking reimbursement for these services can be very complicated as both private and public payors critically scrutinize imaging services. Often, individual payers have their own specific rules that take priority when being billed, further complicating an already challenging claims process. In this blog, we examine the difficulties in radiology coding and provide radiology billing and coding solutions to help you keep abreast of changes in the field.

AMA, CMS, and ACR Coding Guidelines

The American Medical Association (AMA), Centers for Medicare and Medicaid Services (CMS) and American College of Radiology (ACR) have provided guidelines to help coders submit accurate claims. When the national healthcare reimbursement system transitioned from ICD-9 to ICD-10, greater specificity was required in diagnostic radiology coding. Compared to ICD-9 which included 17,000 codes, ICD-10 contains 68,000 codes. The increased specificity of ICD-10-CM requires greater attention to detail when assigning codes.

Like ICD-9, spelling is important in ICD-10 which can be considered a language separate from but related to the medical terminology commonly used in patient care. The specificity of ICD-10 coding allows third-party payers to more accurately track their beneficiaries’ ongoing treatment.

The American Medical Association’s CPT code manual is revised every year to reflect current technologies and newer services. On January 1, 2018, several new CPT codes replaced some obsolete codes. The major coding changes are in Chest and Abdominal X-ray coding with a few changes in Interventional Radiology and Ultrasound.

Chest X-ray Codes

The revisions in the chest X-ray codes do not reflect the specific X-ray views as was done in the past. Instead, the number of views performed are reflected in the 2018 codes. The new codes for 2018 are:

  • 71045: Radiologic examination, chest; 1 view chest
  • 71046: 2 views chest
  • 71047: 3 views chest
  • 71048: 4 or more views

Abdominal X-ray Codes

The revisions for abdominal X-ray codes do not reflect the view specific codes. Instead, the new codes specify the number of views. View specific language such as the complete acute abdominal series code 74022 has been retained. This code requires specific services that require certain views to complete the service. New Codes for 2018 are as follows:

  • 74018: Radiologic examination, abdomen 1 view
  • 74019: 2 views
  • 74021: 3 or more views

Effect January 1, 2018, HCPS codes in Mammography such as G0202, G0204, G0206 have been replaced by CPT codes 77067, 77066 and 77065. Details of the new codes are as follows:

  • 77067: Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (cad) when performed
  • 77066: Diagnostic mammography, including computer-aided detection
  • (cad) when performed; bilateral
  • 77065: Diagnostic mammography, including computer-aided detection
  • (cad) when performed; unilateral

Fluoroscopy Revised Code for 2018

  • 76000: Fluoroscopy (separate procedure), up to 1-hour physician or other qualified health care professional time

Ultrasound revised 2018 codes

  • 76881: Ultrasound, complete joint (i.e., joint space and peri-articular soft tissue structures real time with image documentation.
  • 76882: Ultrasound, limited, joint or other nonvascular extremity structure(s) (e.g., joint space, peri-articular tendon(s), muscle(s), nerve(s), other soft tissue structure(s), or soft tissue mass(es), real -time with image documentation.

Interventional Radiology

CPT codes for endovascular aneurysm repair (EVAR) have been completely overhauled for 2018 with the introduction of 20 new codes. In addition, the codes for other vascular procedures have also been updated.

The American College of Surgeons, the Society of Interventional Radiology, the Society of Thoracic Surgery, the American College of Cardiology, and the Society for Cardiovascular Angiography and Interventions collaborated to restructure the EVAR codes. They were led to change the codes due to the recognition that the existing codes undervalued the work involved in EVAR. For example, they did not differentiate between ruptured and elective aneurysm repair, nor did they recognize the unique challenges and advantages of percutaneous access.

The new EVAR CPT codes have been designed to reflect the work involved in performing the procedures based upon the anatomy of the aneurysm and the treated vessels rather than being device-based. They now reflect clinical scenarios more accurately. The new codes have bundled all catheter placements, radiologic imaging and supervision, and interventions within the treatment area. Areas outside the treatment zone may be billed separately.

Other CPT Coding Changes

Other CPT coding changes affecting vascular surgeons for 2018 include the creation of four new codes for treatment of incompetent veins via transcatheter ablation using adhesive glue (CPT 36465 and 36466) and ultrasound-guided foam ablation (36482 and 36483).

For 2018, angiography of the extremities (75710 and 75716) will be better reimbursed while Sclerotherapy of single and multiple veins (codes 36470 and 36471) has been downgraded from 1.10 and 2.49 to 0.75 and 1.5 RVUs, respectively.

Creating a Complete Radiology Report

The golden rule of medical coding is that “if something is not documented then it was not done.” Therefore, the American College of Radiology (ACR) practice guideline states that a complete radiology report is mandatory to support proper code assignment and optimal reimbursement. The following elements, at the very least, are a must in the radiology report:

  • Patient name
  • Referring physician name
  • Date and time of study
  • Patient history
  • Reason for the study

According to the ACR practice guideline, the radiology report “should address or answer any specific clinical questions. If there are factors that prevent answering of the clinical question, this should be stated explicitly.” The guideline also recommends documenting the date of the report’s dictation and date and time of transcription, in addition to the radiologist’s signature.

Radiology Billing and Coding Solutions

The intricacies and nuances of coding can make or break the success of your claims. Coding isn’t for the lighthearted or the inexperienced. The right coding has the power to reduce denials and exponentially increase successful claims. Accurate coding means accurate charges for every patient treatment, consultation, and medication. On the other hand, sluggish, inaccurate coding can back up revenue in a traffic jam of denials. You can prevent these costly mistakes by knowing all coding updates as well as the specific challenges faced in your practice or hospital. Having a complete radiology report can help ensure you and your team are using the right codes. Coding precision and accuracy results in maximum revenue for any healthcare organization.

InfinxRadiology Coding Guidelines and Best Practices

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