You are not alone on this "battle." I've fought it myself.
Here's what I recommend:
1.) 2008 ICD-9-CM, under Section IV (Diagnostic Coding & Reporting Guidelines for Outpatient Services), part L, third paragraph, "For outpatient encounters for diagnostic tests that have been interpreted by a physician, and the final report is available at the time of coding, code any confirmed or definitive diagnosis(es) documented in the interpretation. Do not code related signs and symptoms as additional diagnoses."
This typically includes any incidental findings, or additional "abnormalities" noted on the report. Keep in mind that even if we are coding inpatient, professional fee, we still abide by the OP guidelines.
2.) Also in ICD, under Section I.B.8, "Conditions that are not an integral part of a disease process . . . should be coded when present."
3.) Per the ACR (these are the Radiology practice guidelines--general, diagnostic):
"Findings that the diagnostic imager
reasonably believes may be seriously
adverse to the patientâ€™s health and are
unexpected by the treating or referring
physician," should be communicated to the requesting provider. Basically it is saying that things reported in the findings or body of the report (and deemed important to the examiner) are worthy of mentioning. Inasmuch, if it is mentioned in the impression, I would say it should definitely be coded.
What you're doing is fine. If these "non-coding" folks have objections, tell them to forward their queries to ACR and ICD.
Hope this helps.
Kevin B. Shields, RHIT, CPCO, CCS, CPC, COC, CCS-P, CPC-P, CPC-I