Radiology Coding Alert

Keep on top of which codes your payer prefers

You can't always count on CPT guidelines to tell you how to code for the numerous payers you deal with every day. These surefire tactics keep you organized so you can choose the right code every time. 1. Chart Those Choices 
 
Set up a spreadsheet "to keep track of frequently applicable payer policies and quirky filing requirements," says Jim Collins, CPC, ACS-CA, CHCC, president of Compliant MD Inc. in Matthews, N.C.

Try this: For your "cheat sheet," Rachel Mitchell, CPC-H, an AAPC-approved PMCC instructor with Applied Medical Services in Durham, N.C, suggests the following: Note which codes each payer accepts for common procedures, which codes they never accept, which diagnosis codes they allow for each procedure code, which modifiers the payer allows, and how you should report them.
 
Example: You may have one payer that wants you to place "2" in the unit box if you use modifier -50 (Bilateral procedure) and another who asks you to place a "1" in the unit box for that modifier, and you should make sure this information is at hand in your spreadsheet. 2. Don't Let Your Guard Down To stay current on your payers' policies, you have to dig through their newsletters and Web sites, Mitchell says. "It's legwork," she says.
 
Her company has found success by appointing one quality-assurance person to be responsible for Internet research. Since CMS has made a point of going paperless, you have to be doubly vigilant in checking for Medicare and Medicaid online bulletins, Mitchell says.

What to do: If your patient is covered by TrailBlazer Health in Texas, and you go to this Medicare carrier's Web site (www.trailblazerhealth.com), in the center of the page you'll see a "What's New" column to help you keep up with the latest information.

If you have a question about a specific policy, click on "Texas" under "Part B" on the left side of the screen. Then to find a policy for a particular procedure, click on "LCD (Local Coverage Determination)" in the left-hand column. You can search by the name of the procedure or the CPT Codes itself.
 
Example: You have a report of an MRI of the head and neck for a patient with meningitis due to the ECHO virus, and you want to make sure TrailBlazer policy says the diagnosis code you think is right proves medical necessity for this MRI. You know the procedure code is 70540 (Magnetic resonance [e.g., proton] imaging, orbit, face, and neck; without contrast material[s]). 1. Type 70540 into the search field on your page. This will bring up links to the LCDs for this code. In this case, there is only one, and when you click [...]