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Radiology Coding Alert

You Be the Coder:

Can I Hold a Claim Until I Have a Dx?

Question: When we see a patient for a new problem, such as cough and fever, I usually report the appropriate x-ray code with a cough diagnosis (ICD-9 786.2 ). If the patient returns for subsequent visits, we usually have a more definitive diagnosis, such as bronchopneumonia (485), and I report that instead. My office manager thinks we should hold the first x-ray claim until we have the definitive diagnosis, so that all of the patients visits have the same ICD-9 Code (485). Is she correct?

Colorado Subscriber
Answer: The ICD-9 guidelines state, If symptoms are present but a definitive diagnosis has not yet been determined, code the symptoms. Your question indicates that the patients bronchopneumonia was not diagnosed until after the physician read her x-ray. If this is the case, you should report the appropriate chest x-ray code (71010-71035) for the initial x-ray and link it to the cough diagnosis code (786.2).

After the attending physician determines a diagnosis, you should report only the new diagnosis code (485) if the patient presents for subsequent tests, and you should no longer use the cough ICD-9 code.

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