Radiology Coding Alert

Question: I know that the chest pain diagnosis codes require a fifth digit, but I dont always know which to assign. In those cases, is it all right to use 786.50?

Ohio Subscriber  
Answer: It depends. Codes 786.50 (chest pain, unspecified) and 786.59 (chest pain, other) are often considered dump codes.  These two codes describe chest pain that has not been clinically defined. However, they shouldnt be used simply because the coder cant find the definitive diagnosis in the radiology report. Coders should review the notes carefully to assign a diagnosis code to the highest specificity possible. This is particularly vital for diagnoses like chest pain, which require a fifth digit. For instance, the notes may indicate that it hurts when the patient takes a deep breath. This would be reported with 786.52 (chest pain; painful respiration).
 
Coding experts have differing opinions about what coders should do if information in the radiology report doesnt provide adequate specificity. Some suggest asking the radiologist if more information is available. Others recommend against this approach and say coders should report only whats contained in the original report. If, in either case, no additional information is available, it is acceptable to report 786.50 or 786.59.  
Reader Questions were reviewed by Donna Richmond, RCC, CPC, radiology coding specialist with Acadiana Computer Systems Inc., a medical billing management company based in Lafayette, La., which serves more than 200 radiologists, pathologists and anesthesiologists; Gary Dorfman, MD, FACR, FSCVIR, past president of the Society for Cardiovascular and Interventional Radiology (SCVIR) and president of Health Care Value Systems in North Kingstown, R.I, which provides practice management services as well as revenue optimization techniques through coding and billing support; and Cindy Parman, CPC, CPC-H, co-owner of Coding Strategies Inc., an Atlanta-based firm that supports 1,000 radiologists and 350 physicians from other specialty areas.