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Don't Fall Prey to the Top 2 Radiology Coding Mishaps

Your tech's observation may not capture all the proper codes
Charges for interventional radiology services often fall by the wayside because coders don't always read the details of the reports, operating under the assumption that the radiology technician has covered the details. But taking a second look could save you loads of reimbursement you may not even know you're losing.
Stumbling block #1: Techs coding from their experience - not documentation.
The number-one problem with reporting interventional radiology codes in a facility setting is that many hospitals rely on the tech to catch all the charges during or immediately after the procedure, says Cindy Parman, CPC, CPC-H, RCC, president-elect of the 星空入口National Advisory Board and co-owner of Coding Strategies Inc. in Atlanta. In some facilities, the tech even enters the data straight into the billing system.
The problem with this, Parman says, is that no one has the benefit of coding directly from the dictated radiology report that lists all procedures and imaging services performed. "This generally leads to underbilling of services, or in some cases overbilling, because the techs capture what they think was performed, in the quantity that they think they saw, when physician dictation supports other services and quantities."
Stumbling block #2: Hospitals think they can't have reimbursement for both the imaging guidance code and the procedure code.
Facilities count on a number of technical staff members to capture "charges," which creates a different mind-set than just assigning codes for services performed, Parman says. So they capture "charges" through the charge description master (CDM), in most cases using internally assigned four-digit codes. "As a result, if a radiology technician was capturing the 'charge' for an interventional procedure, she may only assign one CDM code - which would equal only one CPT code - which would ultimately lead to only one APC reimbursement," Parman says.
For example, with an abscess drainage that supports both codes 49080 (Peritoneocentesis, abdominal paracentesis, or peritoneal lavage [diagnostic or therapeutic]; initial) and 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation), Parman says, "The tech may capture the CDM code that equates to either 49080 or 76942, but may not capture both codes to report a single procedure."

- Published on 2004-01-02