Need Help Finding out the right dx code in Radiology coding

NikhilCPC

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Hi All I need one help from your side i need to know that in Radiology if we have to Radiology coding then for finding out the right dx code first we have chief complaint & second finding or Impression option so what would be the primary diagnosis code would it be chief complaint or which would be find out through finding or impression. so tell me the correct way to find out the correct dx code. your help would be very apprcieated.



Thanks & Regards,
Nikhil
 

darmentd

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You should code from the radiologist's impression, that is your final diagnosis. If your diagnosis is normal you would use your cheif complaint (reason for procedure) as your diagnosis.

If you are coding medicare patients please be aware of coding criteria, sometimes a cheif complaint will cover but the final diagnosis will not & in that case I recommend using the cheif complaint first followed by the final diagnosis. While I understand that is not really the best scenario it is what works best for reimbursement.
 

jgf-CPC

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Code first from the impression from the Radiologist. Also if you do not have any signs or symptoms from the referring physician and the test is normal you could also use the patient's chief complaint.
 
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