Coding Guidelines

Can You Code Symptoms And A Definitive Diagnosis Together?

If you’ve been an outpatient coder for a while, you may know the answer to this off the top of your head. However, if you’re new to coding, you may not, so I thought it would be helpful to go over this guideline real quick. Before we even get started, I just wanted to say that as a general rule, in outpatient coding, you would not code the symptoms and the findings together. For example, let’s take a radiology coding example because I admit I’m biased and it’s my favorite. Say if a patient goes to get an x-ray of their elbow for pain, and it turns out, they have a fracture, you would code the fracture and not the pain, since the fracture is the finding. Pretty easy, right? But there is a guideline that I admit, I didn’t really even think about until not that long ago. You can turn to it in your ICD-10-CM book. It is in the front of the book in the guidelines, for chapter 18, b. Here is a pic just to make it easier:

 

So basically what this guideline is saying is that sometimes you can assign symptoms when it’s not associated with the definitive diagnosis. You would code the diagnosis first, then the symptoms. This is something I don’t see too often in radiology coding. Is this something you’ve coded before? Does anyone have an example they can share? Anyway, then it goes on to say that signs and symptoms associated with a definitive diagnosis are not coded with the diagnosis. This is the part that most coders seem to know.

Anyone have any comments on this? Examples? Please share in the comments below.

 

Midnight Medical Coding Products You Might Be Interested In:

 

Learn The 50 Most Common X-Ray CPT Codes-

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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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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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modifiers

Difference Between Modifiers 76 and 77

For this week, I thought I’d talk about 2 common modifiers used in diagnostic radiology–modifier 76 and 77. Let’s be honest though–talking about modifiers is probably not the most exciting coding thing to talk about–but it’s important. I’ll do my best to explain it in such a way that you actually read the whole article without getting bored– 🙂

So–modifier 76. If you look at the CPT book it says-

Ok, so the keywords here are ‘Repeat Procedure’ and ‘Same Physician.”

 

Now let’s look at modifier 77:

 

The keywords to look at here are ‘Repeat Procedure‘ by “Another Physician.’

So the difference between these modifiers is that modifier 76 is for a repeat procedure by the same physician on the same day, and modifier 77 is for a repeat procedure by a different physician on the same day.

In diagnostic radiology, I would say these modifiers are most commonly used on x-rays. Sometimes the same patient might need the same x-ray taken a few times during the course of the day. It could be x-rays for broken bones or chest x-rays to monitor different issues over time.

 

Le’ts look at a very common code- 71045. This is the CPT code for a 1 view chest x-ray.

 

Say if a patient had:

A 71045 was done at 8 am- read by Dr Smith, then later the same day

A 71045- done at 2 pm- read by Dr Smith

So basically this patient had 71045 done twice the same day. To bill these out, you have to add a modifier. In this case, this is the same procedure, read by the same physician. What modifier would you use?

You would add a modifier 76 to show that it’s a repeat CPT read by same radiologist. The 76 would go on the 71045 billed at 2 pm.

 

Let’s look at another example:

Say if a patient had:

71045 done at 9 am, read by Dr Smith, then later the same day

71045 done at 2 pm ready by Dr Jones

Now which modifier would you use? You would use a modifier 77 to show that this patient had 2 separate 71045’s done the same day, but NOT read by the same dr. You would add a modifier 77 on the 71045 from 2 pm. Does this make sense? You would use these modifiers to bill out 2 separate 71045’s the same day. You’re just trying to tell the insurance company if the same radiologist read the films or not. If you forget to add these modifiers, the insurance company most likely will think you made a mistake and billed out the same exam twice and deny one.

**Just a reminder–always follow client specific guidelines and insurance specific guidelines.

Questions? Feel free to comment below or email me at mightmedicalcoding@gmail.com.

 

Thanks for reading-

Lindsay

 

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 Questions 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

 

 

 

 

 

 

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ICD-10 Coding Tips

Beginners Guide To Coding Fractures Using ICD-10-CM-Part 2

Ok, as a follow up to last weeks post about 7th character A, for this week I thought I’d talk about 7th character D and more just about fracture coding in general. Here is a pic from my book:

 

Please see the pic where I have the star. It says 7th character D is used for encounters after the patient has completed active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase. Ok, just like I mentioned in the last blog post,  the 7th character is not determined by provider or how many visits the patient has had, or anything like that. It just has to do with if the patient is in the healing/recovery phase or not. Examples of the recovery phase: if the patient is having x-rays to determine how a fracture is healing= 7th character D. Sometimes keywords in the report help as well. A radiologist will never say “patient is now in recovery/healing phase.” Keywords for healing is if the documentation mentions “callus formation.” Callus formation means the bones are healing.

Just in general, here are some more facts about fracture coding. These are all found in the ICD-10-CM Book in the guidelines about fracture coding. All fractures default to a displaced fracture if it is not documented as displaced or nondisplaced. (Displaced basically just means the bones are not lined up right). If the report specifies ‘nondisplaced’ fracture, then code it as nondisplaced.

All fractures default to a “closed” fracture if it’s not documented. Closed fracture means that there’s a broken bone but it is not coming out through the skin. This is really gross to think about but since we’re coders, we have to. Basically, if the report states “open fracture,” you’d code it as open fracture. But what that means is that the bone is so broken and messed up that you’d be able to see it. It’s through the skin (these are very bad fractures, sometimes from gunshot wounds and those types of injuries). Don’t worry–I will never post any real pics of fractures or anything on this site. Even though I can read reports for work, I can not look at real pictures or video of anything medical without completely losing it and feeling sick. Not sure if everyone is like that, but I’m the worst. It’s amazing I can even work as a coder I’m so bad with it.

Here are some different types of fractures, but these are drawings so I can handle it 🙂

 

 

Do you have any questions about fracture coding? Please comment below or email me at midnightmedicalcoding@gmail.com.

Thanks for reading-

Lindsay

 

Other Midnight Medical Coding Products you may be interested in:

 

Learn The 50 Most Common X-Ray CPT Codes-

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

 

 

 

15 Questions 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

 

 

 

 

 

 

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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

coding challenge

Coding Challenge 5

Please code the ICD-10-CM and CPT code for this report. To check your answers, click the link at the bottom of the report.

ABC Hospital

Patient Name- Jon Doe

Date- 1/1/18

Referring Dr- Dr Smith

Exam- US Renal

—————————————————————————————————————–

Procedure- US Renal

History- Routine check of renal cysts

Technique-2D images

Findings- Complete evaluation of the right kidney. Right kidney is normal in size with no hydronephrosis. No calculus. Simple cyst measuring 1.4 x 2.1 x 3.6 located mid portion. Simple cyst #2 measuring 1.7x 1.9 x 1.6 located upper pole.

RT kidney retroperitoneal measurements- length 9.71 AP 5.04 cm. width 5.52 cm

Complete evaluation of the left kidney. The kidney is normal in size with no hydronephrosis. Complex cyst measuring 2.2x 1.2x 1.5 located mid portion. Visualized portion of the IVC are normal. Proximal and abdominal aorta obscured by bowel gas.

LT kidney retroperitoneal measurements- length 11.50 cm AP width 6.25 cam

The bladder is normal.

Prostate is normal.

Impression- No hydronephrosis. Bilateral renal cysts.

Signed by Dr Michaels 4:00 pm 1/1/18

Go here to check your answers!

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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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