Vol. 13 Issue 10
Basics of Coding Diagnostic Radiology Procedures: Test Your Coding Skills
Radiology coding can be difficult because it is often "split." That is, the physician bills for the professional component of a service or procedure, and the hospital bills for the facility or technical component. In addition, each third-party payer may have specific guidelines.
Radiology is used in many different ways, including for diagnostic purposes. In diagnostic radiology, direct ionizing radiation is passed through the body's soft tissue and stopped by hard tissue, creating an image on photographic film. This original technique was developed at the turn of the century and led to the establishment of the field of radiology. Physicians commonly use X-rays to examine bones for signs of fractures and the chest for signs of pneumonia. More exams are performed in diagnostic radiology than any other modality, and a variety of new techniques are available.
To code correctly for extremity radiographs, follow these simple steps.
1. Determine the area radiographed.
2. Determine the number of views taken.
3. Assign the appropriate code.
4. Assign the appropriate modifier (as needed).
Test Your Coding Skills
See if you can assign the correct code for the following four examples before looking at the answers below.
Example 1:.The radiology department performs a routine three-view study of the right wrist.
Example 2:.A patient comes into your hospital emergency room with a broken wrist. The radiology department performs a two-view left wrist X-ray.
Example 3:.The radiology department performs a two-view study of a patient's right ankle. With the patient still in the room, the films are reviewed and two additional films are taken.
Example 4:.A one-view study of a patient's left ankle is performed.
Answers to Examples
To find the answers to all of the above, you would, of course, first consult the CPT manual index. You might instinctively think to search for the code under the entry Diagnostic Radiology Examination, and you would be referred to Radiology, Diagnostic where only "unlisted services and procedures" is listed.
The following entry is for Examination, which lists code 70030. Going back to the radiology section code descriptions, you would see that code 70030 is for "radiologic examination, eye, for detections of foreign body"–obviously not the code you need.
However, if you immediately turned to the word X-ray in the index, then to Wrist, you would be referred to the code range of 73100Ð73110. In this range, there are two codes listed. From these you will find the correct codes to assign for the first two examples above. (See below for discussion of modifiers assigned.)
Example 1:.73110-RT Radiologic examination, wrist; complete, minimum of three views
Example 2:.73100-LT Radiologic examination, wrist; two views
Also under the X-ray entry in the CPT index, you would go to anklethe site of the exam on the next two examples. The code range 73600Ð73610 is listed. Again, only two codes are listed for this range, and the answers for the last two examples can be found there.
Example 3:.73610-RT Radiologic examination, ankle; complete, minimum of three views
Example 4:.73600-52-LT Radiologic examination, ankle; two views
Modifier Usage Explained
All of the above examples use either modifier -LT or -RT (both level II modifiers), which are defined as follows.
-LT Left Side: Used to identify procedures performed on the left side of the body
-RT Right Side: Used to identify procedures performed on the right side of the body
These modifiers apply to codes that identify procedures that can be performed on paired body parts or organs, such as extremities. When trying to decide whether or not to use the -LT or -RT modifier, ask this question: "Is this code referring to a procedure done on a body part that is paired?" If the answer is yes, then ask: "Is there another modifier that would more specifically describe the procedure being performed?" If the answer is no, then you should select the appropriate modifier to append to the code depending on the side of the body where the procedure was performed.
The -LT and -RT modifiers should be used whenever a procedure is performed on only one side of the body (except when modifier 50–bilateral procedure–applies). In addition to diagnostic radiology as well as supervision and interpretation (S&I) codes, they may be used on surgical procedure codes (10XXXÐ69XXX).
The modifier assignment for the fourth example above is slightly different because, in addition to -LT, modifier -52 is assigned. Because no codes exist that describe one-view extremity studies, it is necessary to use this modifier, which is for "reduced services" to describe the radiological study.
One important phrase in the CPT description of modifier -52 is "physician's discretion." As indicated, under certain circumstances a service or procedure is partially reduced or eliminated at the physician's discretion. When this occurs, the procedure code plus modifier -52 can identify that a reduced service was provided. When reporting the professional component, you may use modifier code 09952 as an alternative to modifier -52.
Peggy Hapner is health information management consulting division manager at Medical Learning Inc. (MedLearn®), St. Paul, MN.