Radiology Coding Alert

Don't let these coding errors sink your claims You assigned the correct CPT Codes and appended all of the required modifiers, but the carrier still denied your claim. You may be a victim of some common diagnosis coding myths that made you assign incorrect ICD-9 Codes to your claim.
 
The following radiology coding scenarios will show you how to tighten up your diagnosis coding to guarantee quick reimbursement. Myth #1: Once you precertify, you can't add diagnoses. You precertified a surgery based on one diagnosis, but after the radiologist started the procedure he discovered other problems requiring surgical attention. Because you precertified only the original diagnosis, you can't report the additional procedures, right?
 
Not so fast. You can either precertify a code range or submit the follow-up diagnoses after the fact, says Elisabeth P. Fulton, CPC, a coding and auditing department supervisor in Winston-Salem, N.C.
 
Suppose the radiologist preapproves thoracentesis (32000, Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent) for a patient with pleural effusion (511.9). After the radiologist begins the procedure, he aspirates a small amount of blood and pus from the patient's lung, which means that the patient actually has hemothorax (511.8). The radiologist inserts a chest tube and performs thoracostomy to remove the fluid (32020, Tube thoracostomy with or without water seal [e.g., for abscess, hemothorax, empyema] [separate procedure]). Because the insurer only preauthorized the procedure based on the pleural effusion diagnosis, should the practice report both conditions?
 
Yes, but you can avoid this challenge if you precertify a code range rather than just one code, Fulton says. "Before the surgery, tell the insurer's precertification department that the surgeon may perform other procedures if he discovers additional diagnoses," she says. "We tell the insurance company's precertification department that the surgeon may very well perform more than one procedure, depending on what he discovers when he gets in and looks around."

Insurers rarely ask physicians to precertify just one CPT and diagnosis code. In rare cases, however, the insurer might ask you to simply precertify the intended procedure based on the confirmed diagnosis. In this case, you should precertify 32000, but you should reiterate that it is completely possible that you may perform and report more procedures if medically necessary.
 
If, after the surgery, the insurance company balks at paying for the thoracostomy, the interventional radiologist should write an appeal letter citing the date his practice requested preapproval, the fact that the practice attempted to precertify a code range, and the fact that he diagnosed hemothorax during the thoracentesis. Myth #2: You can no longer report signs [...]