Radiology Coding Alert

Correct Coding of Each Thyroid Diagnostic Procedure Performed Leads to Reimbursement

- Published on Tue, Feb 01, 2000
"In making preliminary evaluations of a thyroid disorder, an ultrasound often will be conducted (CPT 76536 , echography, soft tissues of the head and neck [e.g. thyroid, parathyroid, parotid], B-scan and/or real time with image documentation). Then more extensive exams are ordered, depending on conclusions drawn from the ultrasound. Each of these procedures demands careful coding to ensure that a radiology practice receives optimum reimbursement.

Diagnosing and treating thyroid disease was recently in the news when doctors caring for Tipper Gore, wife of Vice President Al Gore, discovered a nodule located on her thyroid gland. Gore underwent a thyroid lobectomy to remove the growth, which was found to be benign. Radiologists commenting on this course of treatment point out that there are several less invasive diagnostic procedures that frequently are used to determine the nature of nodules like Gores.

According to Harvey A. Ziessman, MD, director of nuclear medicine in the department of radiology at Georgetown University Medical Center, the two most common diagnostic procedures used are thyroid scans (with or without uptake) and needle biopsies, and they often are performed in conjunction with one another. When coding thyroid procedures, coders must recognize that an uptake study was done and, if so, whether single or multiple determinations are made. Coders also should note if no imaging is done in addition to the uptake. Finally, when assigning codes to biopsy procedures, they must be alert to the type of service provided, as well as a variety of guidance technologies that could be used.

Coding Nuclear Radiology Thyroid Scans

Among the conditions that may indicate thyroid scanning are swelling, mass, or lump in head and neck (784.2), which was Gores diagnosis; goiter, unspecified, enlargement of thyroid (240.9); abnormal loss of weight (ICD-9 783.2 ); tachycardia, unspecified (785.0); and palpitations (785.1).

The procedure consists of a nuclear radiologist administering radioactive iodine. After a number of hoursusually four or sixradiation levels are measured (defined as the uptake study) and/or the gland is imaged. If the nodule is hot or takes up more radioactive iodine than the rest of the thyroid gland, he notes, we are able to rule out malignancy with a high degree of certainty. However, if the nodule is cold and exhibits little or no uptake, there is a 15 to 20 percent probability of malignancy.

Correct coding of a radioactive iodine thyroid procedure is determined by:

1. whether a single or multiple determination uptake study is conducted, and

2. whether imaging takes place.

The most commonly assigned code is 78006 (thyroid imaging, with uptake; single determination), says Donna Richmond, CPC, of Acadiana Computer Systems, a medical billing management company based in Lafayette, La., which serves more than 200 radiologists, pathologists and [...]

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