Before you code, know its basics.
By Brenda Edwards, CPC, CPMA, CPC-I, CEMC
When it comes to procedure coding, radiology is a world of its own, unlike either evaluation and management (E/M) encounters or surgery. If you are unfamiliar with radiology, here are some basic things to know before you code.
Learn the Language
It is important to understand the terminology used to describe how the patient is placed for the projection of the films to be taken. For example, a report may indicate the patient was in the anteroposterior (AP) position, which describes the front of the patient being closest to the X-ray machine and the X-ray traveling from the front to the back of the patient. Other positioning terms include posteroanterior (PA), lateral, dorsal, supine, prone, decubitus, recumbent, and oblique, etc. Consult a medical dictionary for complete definitions (and possible illustrations) of these positions.
The position of the patient may dictate what procedure code to use, as demonstrated by 71035 Radiological exam of chest, special views (eg, lateral, decubitus, Bucky studies).
Understand Component Coding
The majority of radiological procedure codes have both a professional component and a technical component. The professional component identifies the service performed by a physician who interprets the film or study, and is identified by appending modifier 26 Professional component to the appropriate radiology CPT® code. The technical component includes the services of the technologist and the use of the equipment and films, and is represented with modifier TC Technical component. This is known as “component coding.”
If the provider who interprets the film also owns the equipment, a global service is submitted and the professional and technical components are billed together (e.g., the appropriate CPT® code is reported without either modifier 26 or TC appended). The global procedure code is submitted at full fee.
To code correctly, you must know the location where a film was taken and who owns the equipment. For example, a chest X-ray is performed in a freestanding radiology clinic, and a physician who is not employed by the facility interprets the films. In this example, modifier TC is appended to the procedure code because the facility took the films and used its supplies and staff to perform the service. The physician who interprets the X-ray submits a claim with modifier 26 appended for interpreting the film(s). The fee is split, with generally 60 percent of payment going to the technical component and 40 percent for the professional component.
Pay Attention to the Number of Views
Documentation of the number of views taken in an X-ray is crucial because this can affect the selection of the CPT® code. If the number of views is fewer than described by the CPT® code (and another, specific CPT® describing that number of views is not available), modifier 52 Reduced services would be appended to indicate the service provided was less than that described by the code.
For example, a provider orders an X-ray of the left wrist, but only wants one view taken. The minimum number of views for a wrist X-ray is two (73100 Radiologic examination, wrist; 2 views). In this case, you would claim 73100-52 to correctly report one view of the wrist. No additional modifiers would be needed unless the service represented either the professional or technical component.
Expand Your Knowledge
Although “radiology” has historically been used to refer to radiographic films, the term now encompasses all aspects of medical imaging, including ultrasound, nuclear medicine, computerized tomography, and magnetic resonance imaging.
Common practices of radiology include:
- Diagnostic radiology describes diagnostic imaging:
- Radiographic examination (X-ray)
- Computed axial tomography (CT)
- Magnetic resonance imaging (MRI)
- Magnetic resonance angiography (MRA)
- Diagnostic ultrasound uses high frequency sound waves to image structures
- A mode is one dimensional amplitude of sound return (echo)
- M mode is one dimensional with movement (motion)
- B scan is a two dimensional display of movement of tissue and organs (brightness)
- Ultrasound guidance is used in biopsies, aspirations, or injections to assist the radiologist in determining the exact location to place needles, as well as the best route to the site.
- Nuclear medicine uses the placement of radionuclides within the body to diagnose disease and monitor emissions from the radioactive elements. A radioactive isotope is injected and imaged to observe the function of organ. An example of this would be hepatobiliary system imaging to determine the function of the gallbladder.
- Radiation oncology is used to destroy tumors. Steps or stages of treatment are:
- Clinical treatment planning determines treatment dosage, time, choice of treatment and size, and number of treatment ports.
- Simulation determines treatment areas and placement of ports.
- Radiation treatment is the delivery of the radiation.
- Clinical brachytherapy is the placement of radioactive material directly into or surrounding the site of a tumor.
To completely describe the service performed for interventional radiology procedures, codes from radiology and other sections of the CPT® codebook are necessary. Interventional radiologists perform both the radiologic and surgical portions of a procedure.
Documentation of the interventional services must be carefully read to ensure accurate coding and to capture all services performed. Documentation could include procedures for injected materials, placed catheters or guide wires, and imaging. Understanding what is narrated in a radiologic or operative report is very important. If an unfamiliar term is used, query the physician to gain comprehensive knowledge.
Put It All Together
When a surgeon performs the surgical portion of a procedure, the radiologist reports the imaging and/or the other service. For example, the interventional radiologist performs angioplasty; access is gained through a puncture site and imaging techniques are used to guide a catheter into an artery or vein. Contrast material is injected and an angiogram is taken to identify the site of the blockage. A balloon catheter or stent may be used for definitive treatment of the blockage. Further imaging is performed after the treatment to verify the blockage no longer exists.
In this example, the radiologist could potentially have procedure codes for the catheterization, guide wire, balloon catheter or stent, contrast, and imaging. National Correct Coding Initiative (NCCI) edits must be used to ensure procedures and services considered bundled into another service are not separately reported.
Although there are differences between radiology, E/M, and surgical coding, the knowledge gained from learning each is invaluable. Don’t be afraid to venture into the unknown of radiology coding.
Brenda Edwards, CPC, CPMA, CPC-I, CEMC, entered the coding and billing profession 25 years ago. Her responsibilities at Kansas Medical Mutual Insurance Company (KaMMCO) include chart auditing, coding and compliance education, and contributing articles to the company website and publication. Brenda is an AAPC-approved PMCC instructor and an ICD-10 trainer. She is a frequent speaker for local chapters in Kansas and Missouri, and has presented at AAPC regional conferences and workshops. Brenda is on the AAPC Chapter Association Board of Directors.
June 1st, 2012
Attention physicians, non-physician practitioners (NPPs), and independent diagnostic testing facilities (IDTF) supplying imaging services and submitting Medicare claims for the technical component (TC) of advanced diagnostic imaging (ADI) procedures: MLN Matters SE1122 provides assistance to help you meet the accreditation requirements established in Section 135 (a) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).
For you to furnish the TC of ADI services for Medicare beneficiaries, you must be accredited by Jan. 1, 2012 to submit claims with a date of service on or after Jan. 1, 2012.
July 15th, 2011
Physicians should expect claims processing delays when submitting line items with modifier PA Surgery wrong body part, PB Surgery wrong patient, or PC Wrong surgery on patient. Modifier PC, in particular, has created so much confusion among providers, according to the Centers for Medicare & Medicaid Services (CMS), the agency has instructed contractors to suspend, review, and develop all claim lines containing modifier PC , PB, or PA.
Effective Jan. 15, 2009, hospital outpatient departments (HOPDs), ambulatory surgical centers (ASCs), and practioners are required to append the appropriate modifier—PA, PB, or PC—to all lines related to an erroneous surgery.
The problem is, some providers are incorrectly using the PC modifier to report the professional component of a service.
The PC modifier was at one time used to report the professional component of a service when someone other than the physician performed the technical component, which continues to be reported with modifier TC Technical component (hence the confusion). Current guidelines, however, stipulate modifier 26 should be used to report the professional component.
Modifier 26 designates a service as “interpretation only” and is most commonly submitted with diagnostic tests, inlcuding radiological procedures. Part B Medicare Administrative Contractor (MAC) Palmetto GBA refers you to the Medicare Physician Fee Schedule database (MPFSDB) to determine if modifier 26 is applicable to a particular procedure code.
For proper uses of modifiers PA, PB, and PC, read MLN Matters article MM6405. CMS instructs contractors on how to prevent the misuse of modifiers PA, PB, and PC in Transmittal 1867, Change Request 6718, issued Dec. 4.
December 14th, 2009