Medical coding itself is complicated in the healthcare industry. The whole process for reimbursements depends mostly on medical coding. When it comes to radiology coding services, there are various aspects and factors to note, which are quite complex. Unlike other coding specialties, radiology coding involves different codes for different procedures. Radiology coding is unique and it needs accuracy to scrutinize the reimbursement process in an easier way.
Not every healthcare professional can make it happen. Indeed it’s a hazardous task for most of them. Every detail of the procedure including X-ray, imaging and other radiology services must be presented in the documentation before proceeding with the payment process. In their tight schedule it turns out to be an extra burden making it even more difficult to manage the practice. To ensure accuracy, it’s essential to know and follow the radiology coding factors including facts that make the billing process more hassle free.
In this article let’s learn better ways to do radiology coding procedures.
Check for eligible LCD diagnoses in radiology coding:
- Accurately coding for non-invasive vascular diagnostic studies means sticking to the set of authoritative norms, guidelines and instructions.
- It’s important to take diagnostic considerations into account to make sure the claim has an optimal chance at reimbursement process.
- It’s also essential to address the coding mechanics surrounding extra-cranial artery and extremity vein duplex scans.
- Always make sure the coding workflow is free from any obstruction by adhering to these practical tips and tricks.
Meet Key Criteria Parameters for Duplex Scan Coding:
- Healthcare professionals must report extra-cranial Duplex scan using the following codes: 93880 – Duplex scan of extra-cranial arteries; complete bilateral study
- 93882 – unilateral or limited study
- They won’t find any guidelines that will instruct them on any sort of criteria when reporting for 93880-93882, beyond the scope of what’s needed to report Doppler (duplex) scans.
- Refresher: In radiology coding, the professionals have got two ways to meet the criteria for the duplex scan reporting. The initial and one of the most convenient methods include the reporting of duplex study that was performed.
- Radiology professional must typically find documentation supporting this in the findings of the dictation report. Otherwise, he/she needs to confirm documentation of two specific terms: colour Doppler and spectral Doppler.
- While there is necessity for documentation to support the use of colour Doppler, healthcare professionals must depend on the following terms, among others, to be used interchangeably with spectral Doppler.
- Acceleration rate,
- Bandwidth broadening,
- Waveform analysis, and
- Peak systolic velocity
Important note: These criteria apply only to reporting of all duplex Doppler studies.
- Barry Rosenberg, MD, chief of radiology at United Memorial Medical Center in Batavia, New York, explains, “While there are no strict guidelines in place that determine what constitutes a complete bilateral study outside of bilaterality, this study will typically include an examination of the internal, external, and common carotid arteries in addition to the vertebral arteries.”
- When two or more of the aforementioned arteries are not included, or when the professional indicates other reasons for a limited study, the code 93882 should be considered for reporting a bilateral service.
- LCD CONSIDERATIONS: The majority of Medicare Administrative Contractor (MAC) Local Coverage Determinations (LCDs) include most of the generalized diagnoses you might associate with extra-cranial duplex scans.
- It’s important to keep in mind that, submission of diagnoses such as R51 for headache, M54.2 for Cervicalgia will typically result in denials from MACs and most of the commercial insurance companies.
Other Factors for Venous Duplex Scan Reporting:
- Complete guidance on reporting for duplex scans of extremity veins is a little more shaded than that’s encountered for extra-cranial artery duplex scans.
- Beyond that, on the top of generalized duplex scan guideline reporting, there are a few sets of criteria you should consider for accurate coding of the following services:
- 93970 (Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study)
- 93971 (unilateral or limited study)
- According to the American College of Radiology (ACR) Ultrasound Coding User’s Guide, criteria for 93970 lower extremity reporting includes examination of the common femoral, proximal deep femoral, great saphenous, and popliteal veins.
- Examination of calf veins are also included but should not be considered as additional work.
- Criteria for 93970 upper extremity reporting includes the examination of the subclavian, jugular, axillary, brachial, basilic, and cephalic veins. Forearm vein imaging should also be included while performing the procedures.
- Coder’s Note: For bilateral services that don’t meet the above criteria, you will code the service as a limited examination, 93971. One can also report 93971 for unilateral (complete or limited) imaging of upper or lower extremity veins. When the biller or coder has all the criteria for 93970 or 93971 reporting, but the report does not include enough documentation to support a duplex scan, you better contact the healthcare provider for radiology coding queries.
- When the imaging does not include colour or spectral Doppler, you should report the service using 76882 (Ultrasound, limited, joint or other nonvascular extremity structures (e.g., joint space, peri-articular tendons, muscles, nerves, other soft-tissue structures, or soft-tissue masses, real-time with image documentation).
- LCD considerations: For entirely diagnostic purposes, medical coder would find any LCD guidelines on primary diagnosis reporting for generalized extremity venous evaluations. Moreover, most MACs and commercial insurance companies require different primary codes when reporting for 93970 or 93971 while performing the following reasons:
- Pre-surgical conduit mapping for coronary artery bypass graft procedures.
- Pre-surgical vein mapping for peripheral artery bypass.
- Vein mapping for dialysis access.
- For duplex scans of extremity veins performed for pre-surgical conduit mapping for coronary artery bypass graft procedures, list either Z01.810 (Encounter for pre-procedural cardiovascular examination) or Z01.818 (Encounter for other pre-procedural examination) as the primary diagnosis.
- For pre-surgical vein mapping for peripheral artery bypass or vein mapping for dialysis access, report Z01.818 as the primary diagnosis. Findings and any other clinical indications are supposed to be reported as secondary diagnoses for all three services.
Most of these codes and radiology coding procedures should be accurately documented as they are very essential for timely reimbursements.
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