Is your radiology practice leaving money on the table? When Practicefirst performs radiology chart audits, we routinely discover four coding errors that can lead to denials from payers and a significant loss of revenue for practices.
Radiology Coding Error #1: Abdominal Ultrasound
For a complete abdominal ultrasound, CPT 76700, a physician report must indicate that all eight of the following were imaged: Liver, gallbladder, common bile duct, pancreas, spleen, kidneys, upper abdominal aorta, and inferior vena cava. If all eight are not imaged or documented, then the record would be coded as a limited abdominal ultrasound, CPT 76705. The payment difference for Medicare is approximately 27% less for the limited ultrasound.
If a patient is missing one or more of the eight items on the list above— for example, if they have had their gallbladder removed —the provider can document that fact, and a complete abdominal ultrasound can still be coded.
Radiology Coding Error #2: Low-Dose CT Lung Cancer Screening
There are five criteria that patients must meet in order to use HCPCS code G0297. Patients must:
Be 55-77 years of age
Have no signs of lung cancer
Have a 30-pack years or greater history of tobacco smoking (A pack year is calculated by multiplying the number of packs of cigarettes smoked per day by the number of years the person has smoked)
Be a current smoker or have quit within the last 15 years
Have a written order for LDCT from a qualified health professional following a lung cancer screening counseling session that attests to shared decision making having taken place prior to the firsts screening CT.
Only the first criteria (age) can be verified by someone other than the provider. The other four criteria must be explicitly documented in the provider’s report.
Radiology Coding Error #3: Mammogram for Undiagnosed Mass or Nodule
Providers should use the appropriate code to indicate the location, by breast and quadrant, of the mass or nodule.
The following ICD-10 unspecified codes are usually denied by carriers:
N63.0 unspecified lump, unspecified breast
N63.10 unspecified lump right breast, unspecified quadrant
N63.20 unspecified lump left breast, unspecified quadrant
The codes that should be used are:
N63.11 unspecified lump in the right breast, upper outer quadrant
N63.12 unspecified lump in the right breast, upper inner quadrant
N63.13 unspecified lump in the right breast, lower outer quadrant
N63.14 unspecified lump in the right breast, lower inner quadrant
N63.21 unspecified lump in the left breast, upper outer quadrant
N63.22 unspecified lump in the left breast, upper inner quadrant
N63.23 unspecified lump in the left breast, lower outer quadrant
N63.24 unspecified lump in the left breast, lower inner quadrant
Oftentimes providers use a time on a clock to reference the location of the lump. For example, “left breast lump at 10:00” would indicate that the unspecified lump is in the left breast, upper inner quadrant, and code N63.22 should be used.
Problems arise when a provider’s report states that the location of the lump is 12:00, 3:00, 6:00 or 9:00, because coders don’t know which quadrant to code for. If the lump is close to one of these imaginary lines, providers should use a time range (e.g., 2:00-3:00) to indicate how to code correctly.
Radiology Coding Error #4: Infant X-Ray
One of the most common reasons for CPT denial is documentation surrounding infant x-rays. CPT code 73592 (Radiology examination, lower extremity, infant, minimum of 2 views) and CPT code 73092 (Radiology examination, upper extremity, infant, minimum of 2 views) do not indicate specific ages, but many insurance carriers deny these codes for children over the age of 1. Denials are based only on age, not size, of the child.
To avoid denials when using codes 73592 and 73092, providers must consider the age of the patient. If the patient is one year or older, the provider should order, explicitly document and ensure that the acquired images adequately depict the anatomy.
Knowledge and Accuracy Are Key
Precise documentation and accurate coding are critical for radiology and other specialty practices. In addition to medical coding and billing services, Practicefirst performs chart audits and creates customized training programs for providers to ensure that medical practices are receiving the full compensation they deserve.