Questions

Diagnostic Radiology Coding Questions?

Hey Everyone,

For this weeks blog post, I thought I’d have you guys ask me questions. What questions do YOU have about diagnostic radiology coding? It can be about CPT, ICD-10, guidelines etc. Is there anything you’d want me to answer? Please post in the comments below or send me an email at midnightmedicalcoding@gmail.com.

I’ll post the questions and the answer in the blog post for next week.

 

Thanks!

 

 

 

 

 

 

 

 

 

Midnight Medical Coding Products You Might Be Interested In:

 

Learn The 50 Most Common X-Ray CPT Codes-

Self-paced online course. Getting awesome reviews from fellow coders.

 

 

 

15 Question Practice Coding Test

Practice coding the ICD-10-CM and CPT codes of HIPAA compliant X-ray reports. Answers and rationales provided.

 

 

 

 

 

Tabs for the ICD-10-CM Book: Get 60 printed, multi-colored, double-sided tabs. These can be used on any 2019 or 2018 ICD-10-CM book from any publisher.

 

 

 

 

 

 

 

 

 

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Diagnostic Radiology Coding Basics

10 Things You Need To Know Before Coding Diagnostic Radiology

For this week’s post, I thought I’d talk about just some general things relating to diagnostic radiology coding.  Bear in mind, this isn’t the be-all-end-all, everything-you-need-to-know guide. This is just what I would tell a new coder who had limited experience with this specialty in a nutshell.

  1. First things first–radiologists can be vague in their documentation. They like to use words like “consistent with,” “probable,” “rule-out” etc.  In the outpatient setting–you do not code uncertain diagnoses. So if you come across a report with these terms, do not code it. A common phrase I see in the impression on chest x-rays is “consistent with pneumonia.” Since it is not definitive, you would not code the pneumonia–you would code whatever the symptoms are. There is a coding clinic however that states that the use of the words “Evidence of” is not a vague term–so you can code the condition.
  2.  When you’re coding, refer to the impression. If there is a finding, it will be listed here, and this is where you code from. If there are no findings, you would code the history/symptoms stated on the report.
  3. When you’re coding x-rays, you count up the number of views to get the CPT. Sometimes the radiologists may mention images–do not count images. It is not the same thing as views. (If you want to learn more about x-ray coding, don’t miss the boat on our online class).
  4. Another thing to keep in mind is to always follow all client specific guidelines. For example, do you code an addendum? Do you need to add a modifier 26? All of these types of questions will be answered in your client guidelines. (A good rule of thumb is to review your client guidelines before reaching out to the lead coder for questions).
  5. Know the difference between limited and complete ultrasounds (refer to the CPT book).
  6. Know the difference between all the different OB ultrasounds (refer to the CPT book).
  7.  CTA’s must state 3D in the documentation.
  8. Know whether or not you need to code the contrast for MRI and CT scans. Do you code contrast waste? Again, review client guidelines on these types of questions.
  9. Know whether or not you need to code incidentals. The answer to this is generally no, but this is another client guideline type question.
  10. Last but not least, know how to code fractures. If this is new to you, see this previous blog post.

So there you have it. Hopefully this list helped you figure out a little more about diagnostic radiology coding.

Thanks for reading-

 

 

 

 

 

 

 

Midnight Medical Coding Products You Might Be Interested In:

 

Learn The 50 Most Common X-Ray CPT Codes-

Self-paced online course. Getting awesome reviews from fellow coders.

 

 

 

15 Question Practice Coding Test

Practice coding the ICD-10-CM and CPT codes of HIPAA compliant X-ray reports. Answers and rationales provided.

 

 

 

 

 

Join the Midnight Medical Coding Stars- A membership only area where one HIPAA compliant diagnostic radiology report is added each week for you to code the ICD-10-CM and CPT codes. Answers provided.

 

Join the Midnight Medical Coding Stars

 

 

 

 

 

 

Tabs for the ICD-10-CM Book: Get 60 printed, multi-colored, double-sided tabs. These can be used on any 2019 or 2018 ICD-10-CM book from any publisher.

 

 

 

 

 

 

 

 

 

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common coding mistakes, ICD-10-CM Coding Tips

ICD-10-CM Coding Tip About The M50 Series

Say what you will, but there are tons of ICD-10-CM Codes used for the different spine conditions. Even if you are not a newbie coder–it can be confusing. This post is not about all the different codes, but just one specific note for the M50 series. If you look at M50, you will see, ‘Note: Code to the most superior level of the disorder.’ If you’ve never noticed this before, please go check it out in the ICD-10 book right now. Below is a pic of my book and the note is highlighted in orange.

Here is a pic from my book.

So the long and short of it is, you only need to code the disorder for the highest level that’s documented in the report. So say if you’re coding an MRI and the dx is cervical disc disorders with myelopathy, and it’s documented at the C3-C4 level and also C5-C6 in the report–you would only code M50.01. You do not need the code M50.021. I can’t tell you how many times I see coders make this mistake. Here’s the kicker, sometimes it’s not even coders who make this mistake. Sometimes it’s a coding engine. But bear in mind though that there’s no way a coding engine can ‘know’ all the rules. But as coders we have no excuse. When all is said and done, we really just have to know this stuff.

 

 

 

 

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Coding Course

Intro To X-Ray CPT Coding Class Is On Sale!

 

Intro To X-Ray CPT Coding- Learn The 50 Most Common X-Ray CPT Codes is on sale. Today only! There are literally hundreds of CPT codes used in diagnostic radiology coding. Trouble is, these codes are not focused on in many general coding classes. This leaves new coders barely scraping by once they’re on the job, especially if they’re expected to know these codes already. If you’re a newbie or a coder in another specialty who wants to learn the basics of X-Ray CPT coding-this is the class to sign up for! It is all online and self-paced. You can email the instructor (that’s me-Lindsay Della Vella BS, COC) anytime if you have questions. This class is backed up by great reviews from former and current students. I hope you’ll join us! Price is $39.99. Today Only. Payment plan available.

Go HERE to see what exactly is include in the class, read reviews and sign up!

Coding Course

My First Day Working As A Medical Coder

On the first day of my first coding job, I didn’t know what I was doing. I really didn’t. I never coded a real radiology report before. I guess I read a few in my coding classes, but it was something that wasn’t focused on.

Everything I knew about radiology was just based on my life experiences up to that point. I knew what a wrist x-ray was because I needed one before (broke my wrist rollerblading). I knew what an ultrasound was because I have kids and had my fair share of prenatal ultrasounds.

I kind of knew what an MRI was because the machine looked scary to me and I couldn’t see myself ever being brave enough to go in one if needed. I didn’t know what a CT was. Never heard of a CTA or MRA. Didn’t know what spectral doppler was. Needless to say I was confused at my first coding job. I didn’t know what any of this stuff was. I was fortunate enough to have an awesome mentor who helped me with CPT coding and even some diagnosis coding here and there.

But I know not everyone is as lucky as I was. Not everyone has a mentor. Or maybe you don’t feel comfortable asking a coworker for help. Even though I’m not a new coder anymore, I didn’t forget what it was like being new. How I was afraid of coding everything wrong. How I was afraid that I really did not know what I was doing and was not going to make it as a coder.

 

Some of you may know this already–but I’ve put together a new diagnostic radiology coding course. It is geared towards new radiology coders or coders in another specialty who want to learn more about it. It focuses on the CPT coding of x-rays. By the time you finish the course, you will know how to code the CPT for a variety of x-rays. You will be familiar with 50 of the most common ones used and will be prepared for ‘real life’ diagnostic radiology coding. It is all online and self-paced.

Please see the link below for a full description of the course. You’ll see the exact format and what is included. Scroll down the page and you will see a FAQ section and what my students are saying about the class. I hope you’ll join us!

 

Click Here for more info, to see class reviews and to sign up!

 

Click HERE for more info, to see class reviews and to sign up.

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coding challenge

Coding Challenge 7

Please code the CPT and ICD-10-CM code for this report. This report is HIPAA compliant and does not contain PHI.

 

Exam- Right hip including pelvis 2-3 views

Date- June 4, 2018

#1111222222


Exam-Hip x-ray right including pelvis 2-3 views

Clinical History- Right hip pain

Comparison- hip x ray 2/4/17

Technique- 2 views of the right hip and 1 ap view of the pelvis was performed

Findings: Pelvis ring intact. The sacroiliac joints are symmetric. No right hip fracture or dislocation. Punctate ossific density adjacent to the right hip. Left hip unremarkable.

Soft tissue- normal

Impression:

No right hip fracture or dislocation. Punctate ossific density adjacent to the right hip most likely related to degenerative changes.

 

Thank you for referring your patient.

Go here for the answers

coding challenge

Coding Challenge 6

Please read the report below and code the CPT and the ICD-10-CM Code. Please keep in mind that these reports are designed to be as realistic as possible, but everything is HIPAA compliant so the information is not real.

*For the tomo, please use the HCPCS code.

***************************************************************

Procedure- Bilateral Diagnostic Mammogram with Tomo

History- Bilateral breast pain for 2 weeks

Technique- Full field mammography was performed. Bilateral breast tomosynthesis was preformed in the MLO and CC projections. CAD was used as an aid for interpreting this exam.

Comparison: Prior mammo from April 2017

Density- There are scattered fibroglandular densities

Findings: There is no suspicious mass, microcalcifications,  or unexplained distortions.

Impression: No dominant mass or secondary signs of malignancy within either breast. Annual screenings recommended. BIRADS ASSESSMENT- (2) Benign findings.

Signed Dr. J.

Go Here To Check Your Answers

Uncategorized

Why It’s Beneficial To Know How To Code Diagnostic Radiology

I just wanted to shed some light on something. I’m not sure if this is the best topic for one of my first blog posts, but here it is anyway. The other day, the topic of off-shoring came up in a coding discussion. It is a sensitive subject and we can’t pull the wool over our eyes and pretend it’s not there. But I don’t want new coders to feel that they should avoid learning diagnostic radiology coding, thinking it would be a waste of time and abandon ship. The fact is that coding in ALL specialties can end up going off-shore. This is something that happens in any coding specialty and is not diagnostic radiology coding-specific. Say what you will, but this is something that most coders are well aware of, and I have never heard of that fact alone being the sole reason that someone does not pursue radiology coding.

Another thing to keep in mind too, is that coding needs to be audited. Not just radiology coding but all coding, no matter where it is coded originally. Usually the coding gets audited here in the USA. Now, I’m sure there are exceptions to this somewhere out there, but in my experience this has been the case. In order to audit it, you have to know how to code it first right? So if it is something you’re interested in, don’t miss the boat!

Another reason to learn diagnostic radiology coding is because it is a good account for new coders to get their feet wet. Why do they start with the radiology accounts? Because it is easier than starting with other types of coding, say brain surgeries, transplants etc. While it’s true that it is easier than some types of coding, it has it’s own set of rules, and is a specialty in and of itself. If you are a diagnostic radiology coder, not only will you become proficient in aspects of CPT coding, you will become familiar with all sections of the ICD-10-CM book. You use a full range of codes which is a very valuable skill set. Even if you decide not to stay in diagnostic radiology coding–these skills transfer over to other coding specialties.

So, to make a long story short, there are many different coding specialties, and unfortunately some coding does end up going offshore, in ALL specialties. But you would be doing yourself a disservice if you decide not to learn diagnostic radiology coding based on that alone. There are thousands of radiologists in this country and many of them see the benefits of having the coding of their practice stay in the US. Not only that, radiology coding lends itself to learning so many different aspects of CPT and ICD-10-CM coding and these skills are valuable for any coder to have.
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