Radiology Coding Alert

Radiology coding and billing professionals are optimistic about Medicares recent directive prohibiting local carriers from automatically denying claims containing ICD-9 preoperative evaluation codes V72.81-V72.84. Instead, carriers are to consider each claim on its merits and allow those that are clinically indicated.

The diagnosis code used most frequently by radiology practices is ICD-9 V72.83 (other specified preoperative examination) and may be assigned for many surgical procedures. Code V72.81 (pre-operative cardiovascular examination) is used prior to cardiovascular surgery or when the patient has a pre-existing cardiac condition, while V72.82 (preoperative respiratory examination) is reported before respiratory surgery or when a pre-existing respiratory condition exists. Typically, these codes are assigned when patients are seen for chest x-rays prior to surgery (e.g., 71010, radiologic examination, chest; single view, frontal, or 71020, two views, frontal and lateral).

In the past, most local carriers adopted a blanket policy and automatically denied routine pre-op tests that were conducted in the absence of a diagnosed disease related to the test, explains Debby Thomas, coding analyst with Diagnostic Imaging Inc. in Philadelphia. Almost always, the carrier would deny these services because they considered them routine screening, not medically necessary evaluations.

The new directive eliminates this unilateral viewpoint and forces local carriers to accept the V codes supporting medical necessity when appropriate. For example, Thomas says conditions that might support the medical necessity of pre-op chest x-rays include history of cardiovascular disease (e.g., 412, old myocardial infarction), respiratory diseases like asthma (e.g., 493.2, chronic obstructive asthma) or a recent episode of pneumonia (i.e., 480.2, pneumonia due to parainfluenza virus).

The specific circumstances allowing pre-op evaluations will be determined by the local carriers and communicated in local medical review policies. Coding professionals should report the V code as the primary diagnosis code on claim forms since it indicates the reason for the encounter. Diagnosis codes explaining the reason prompting the surgery and clinical conditions for the evaluation would be recorded in the secondary or subsequent positions.

Most radiologists I know are pleased with Medicares new position and expect to see carriers begin to pay for these exams, Thomas says. Usually when Medicare speaks, the carriers listen.