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Radiology/technical and professional

Stephnaie Posted Fri 18th of October, 2013 19:49:44 PM

Can you confirm how the ICD9 of the professional component of radiology is supposed to be coded... by the dx code of "why" the x-ray was ordered or with the dx code of "what" they find? Should the technical component always be billed with the exact same dx as the professional component? We are a billing company and only bill the professional side.

SuperCoder Answered Sun 20th of October, 2013 18:23:35 PM

It depends on the timing of your billing. Patient presents with a cough. Physician orders x-ray. If you bill this out immediately, then you would use ICD-9 code for "cough": 786.2. If you wait until the results are in and the patient has pneumonia, then you can code pneumonia: 486.

Stephnaie Posted Sun 20th of October, 2013 22:04:53 PM

Should the technical component always be billed with the exact same dx as the professional component? We are a billing company and bill the professional side with the results of the test. The facility is billing the TC with signs and symptoms (before the results are in), so the ICD9's are different. This, just recently, is causing a problem with one of our main payers and they are flagging all our claims for medical record.

SuperCoder Answered Mon 21st of October, 2013 05:19:13 AM

The DXs of both the professional and technical component should preferably be the same, however due to billing before the arrival of result there might be a difference in DX codes, as you have rightly noticed. While this is not a wrong practice on the facility's part, but whenever you have the results of the radiology service, those results would have precedence over the signs and symptoms when issuing DX codes. Since you bill the services with the DX codes from the results of the service, you should not have a problem with going through with the claims once you start sending them the results (medical records) according to which you issue DX codes.

Stephnaie Posted Tue 22nd of October, 2013 09:09:54 AM

Our problem is when coding the professional component, we have (and are) coding the result. The TC is coding the signs and symptons and the PCP is coding the signs and sympoms. So our very specific DX code is triggering "pre-existing" with the insurance company because it is the first time they are seeing the DX. We had over 300 claims returned for pre-existing last week. This, as you know, is very costly for us to send all the records and make sure the patient is sending back the form the insurance has requested from them. It also gives the insurance a legit reason to deny paying our claim if all the data they've requested is not returned to them. I'm proposing that we now code the signs and symptoms for all payers so as not to trigger pre-existing. Your thoughts?

SuperCoder Answered Tue 22nd of October, 2013 10:16:55 AM

Coding signs and symptoms while you have the final diagnosis at hand would not be a desirable practice. Other than the option you have suggested, I think you should coordinate with the facility to also code the final result, although in that case, they might need to put in a certain wait period to bill out their claims. This would eventually bring out right codes on the table.

Stephnaie Posted Tue 22nd of October, 2013 11:45:23 AM

Is there a coding rule for coding signs and symptoms vs final dx or is it just not desirable in your opinion?

SuperCoder Answered Wed 23rd of October, 2013 07:03:43 AM

As per ICD-9-CM Official Guidelines for Coding and Reporting, the coding rule for coding signs and symptoms states: "Codes that describe symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes only when a related definitive diagnosis has not been established (confirmed) by the provider." In your case, you have a definitive diagnosis as established by the result of the test. Thus, it follows that coding signs and symptoms when you have the final diagnosis established by the test itself for which you are issuing diagnoses, would not be a desirable practice from a coding rule standpoint and so I would advice against it.

Stephnaie Posted Wed 23rd of October, 2013 08:58:42 AM

Perfect, that's what I was looking for. Thanks.

SuperCoder Answered Wed 23rd of October, 2013 09:35:02 AM

You are welcome.

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