Wiki 3 Radiology Coding ?'s

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birky

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#1. When both a limited retroperitoneal US CPT code 76775 and a bladder US for urine capacity measure/pre-post void residual (CPT code 76857) are ordered on the same dos how are these exams appropriately coded? Do we convert the 76775 lmtd renal US to a complete US (76770) or is it appropriate to bill both 76775 and 76857? We would also like to verify that CPT code 51798 is incorrect to bill for the post-void residual study as our radiologist is dictating a formal report.


#2. When ordering a pre-MRI screen of the orbits for foreign body, we would like to know what is required as far as meeting documention requirements, dictation requirements, and ordering physician requirements. i.e. is it okay to have the orbit dictation on the same report as the MRI, or does it need to be on a totally separate report. Does the facility need to generate 2 requisitions for both the obits and for the MRI? Also, does it meet documention requirements to have both exams listed on the same order from the ordering physician? Also, we are finding a major commercial insurance carrier has started to deny our orbit exams for pre-screening as inclusive to the MRI exam.

#3 Our facility has started to generate a requisition for Intra-operative Fluoroscopy used by a physician other than our hospital based radiologist for placement of VAD's done in the OR. Requisition states PLEASE DICTATE FILM ALSO. Our radiologist are dictating single spot fluoroscopy films for placement of vascular device. Is it appropriate for our radiologists to bill for these spot images? If yes, what CPT code should be assigned?

Thanks in advance for the assistance with these coding questions
 
Question 1. If imaging is done of the kidneys and bladder the most appropriate code is 76770. I would not code each of these exams seperatly unless they are performed at seperate patient encounters and dictated as seperate reports.

Question 2. We have encountered problems getting paid for pre-MRI orbit screening xrays as well. We require the referring physician to order the xray (doesn't matter if it is on the same order as the mri or not) and dictate it seperatly. Most payers bundle this exam into the MRI and we don't expect to get paid for most of them, and just write them off after the denial.

Question 3. When doctors read these spot fluoro films for procedures performed in the O.R. by other doctors the general rule of thumb is you bill the xray code appropriate. For a spot fluoro of the chest done during a central venous catheter placement you would bill a one view CXR 71010. The other recommendation for these exams is to bill the normal code for the imaging portion the the exam but with a 52 modifier to indicate a reduced service because your physician was not in the O.R. at the time of the exam. (e.g. 74220-2652 if billing the the radiologists) Make sure the Rads are actually dictating diagnostic findings for these exams as well! Just saying that flouro was utilized for (enter exam here) will not fly.
 
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