Wiki Radiology coding

[Cnichols10]

I posted this yesterday and got a reply which im grateful for but cant find it today. Anyway the question i have is strictly If i am coding an outpatient radiology xray or ultrasound dexa scan etc.... and the doctors order says one thing that is or maybe isnt medically necessary but the radiologist report shows a medically necessary dx after reading it, Can i code to the radiology report or do i have to code from the order??
Or do i have to report both codes and if I do report both codes does it matter which code goes first??
Example- Doctor orders a dexa scan for screening or some other non medically necessary reason and the radiologist reads it and the pt has osteoporosis or some other medically necessary diagnosis. Do i code from order or radiologist or both and if both what order do i code in for the dx code.

Im new coder and when i get the xrays to code it has always been read by radiologist first before i get it. Thanks for any help at all.

 

[whatwouldyousay]

If the intention of the exam is to screen for a condition it would be appropriate to assign the screening code (Z13.820) as the primary diagnosis and any findings or supporting risk factors as additional diagnosis. I would also suggest to see if there is an office policy on how to determine screening vs diagnostic DXA.

 

[Cnichols10]

Thank you whatwouldyousay, thats kind of the problem. I have asked around the office and it seems no one has an answer. I get screening dx codes from doctor and then radiologist run test and findings come back that the patient does have osteoporosis. I was thinking that i should post the screening code but then I remembered that when they go in and do a screening for colonoscopy and they find something it turns from a screening to whatever they find. That leads me to believe i should code the results and not the screening code. I just want to do it the correct way.