74176-74178 Challenge Exposes How 2011 Coding Links to 2010

Test yourself to ensure you've aced this year's coding changes.

ICD-9 codes for abdominal and pelvic CTs are amongst those most regularly reported to Medicare by radiologists. In 2011, the adding of several codes implies you have to select among a combination of old and new selections to report these services.

Read this sample case study, selecting the ICD-9 codes you report for 2011 and finding if they line up with the study below.

Read the Report and Choose Your ICD-9 Codes

Header: Abdominal as well as pelvic CT including enhance, CT reformation body

Dictated report: CT of abdomen as well as pelvis

Indication: 26-year-old female presenting with abdominal pain, exclude acute appendicitis

Technique: Adjoining axial images were found from the lung bases over the pubic symphysis followed by the ordinary administration of oral as wll as intravenous contrast, 150 cc Isovue-300 at 3 cc/sec. FOV=32 cm.

Findings: Lung windows reveal subpleural opacity present in the right lower lobe, probably demonstrating atelectasis. No parenchymal nodule or mass inside the visualized lung bases. Besides, no pleural or pericardial effusion found.

The liver, gallbladder, adrenal glands, spleen, pancreas, as well as the kidneys are normal. The bladder is amply bloated devoid of evidence for thickening of bladder wall. Both ovaries are envisioned, comprise normal-appearing follicles. Besides, there is also a 2.1- x 1.4-cm physiologic cyst inside the right ovary.

The appendix is swollen, comprises a few 3- to 4-mm appendicoliths, establishes abnormal bowel wall augmentation, and is connected with moderate nearby periappendiceal fat stranding. The left over bowel is normal. No periappendiceal fluid collection or abscess is found.

Impression: Acute appendicitis.

Narrow Code Choices Based on Anatomic Area

In our sample report, the radiologist keeps a note of the state of the abdominal structures (liver, gallbladder, pancreas, intestines) as well as the pelvic structures (bladder, ovaries).

Old way: Prior to 2011, this info would motivate you to narrow your CPT® choices to 74150-74170 (Computed tomography, abdomen ...) as well as 72192-72194 (Computed tomography, pelvis ...).

New way: Your options change with the addition of 2011 codes that symbolize both abdominal and pelvic CTs in just a single code:

74176, i.e. Computed tomography, abdomen as well as pelvis; excluding contrast material

74177, i.e.Computed tomography, abdomen as well as pelvis; including contrast material(s)

74178, i.e. Computed tomography, abdomen and pelvis; excluding contrast material in one or both body regions, trailed by contrast material(s) and additional sections in one or both body regions.

CPT 2011 keeps 74150-74170 (abdomen only) and 72192-72194 (pelvis only), but as the sample case denotes an abdominal as well as pelvic CT in the similar session, you will be selecting from new ICD-9 codes 74176-74178, supposing this case has a 2011 date of service.

37224-37227 Develop Your Femoral/Popliteal Coding Choices

CPT's description of a 'single vessel' for this particular territory is certainly an exception to the rule.

Getting yourself updated on the current year's revascularization CPT changes necessitates more than simply changing your old codes for the new ones -- though that alone is sufficient to keep you busy. You furthermore have to take a watchful look at the guidelines that are applicable to the individual codes to ensure you're using the new codes properly. Read on this expert radiology medical coding article and take a step closer towards accurate and profitable radiology coding.

In the sphere of radiology coding, CPT 2011 adds new codes meant for lower extremity endovascular revascularization including angioplasty, atherectomy, as well as stenting. This radiology medical coding article will concentrate on the femoral/popliteal codes 37224-37227.

Ace the Single Code Approach Meant for Fem/Pop Coding

The newly listed femoral/popliteal service codes are as following. Remember that all of the codes involve angioplasty in the similar vessel when that service is carried out:

Angioplasty: 37224 –i.e. Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; including transluminal angioplasty

Atherectomy (as well as angioplasty): 37225 -- i.e. including atherectomy, with angioplasty in the same vessel, when carried out

Stent (as well as angioplasty): 37226 -- i.e. including transluminal stent placement(s), with angioplasty in the same vessel, when carried out

Stent and atherectomy (as well as angioplasty): 37227 -- i.e. including transluminal stent placement(s) as well as atherectomy, with angioplasty in the same vessel, when carried out

Remember: The broad rule for 37224-37227 is that you must report the one code that denotes the most intensive service conducted in a single lower extremity vessel. All other lesser services are covered in that one code.

Look into the Change from Component Coding

CPT guidelines maintain that -- besides the intervention performed -- the codes include:

To get into the vessel

Selectively catheterizing the given vessel

Crossing the given lesion

Radiological supervision as well as interpretation or understanding for the intervention carried out

Every embolic protection used

Closure of given arteriotomy (incision in the artery)

Imaging carried out to document the intervention was accomplished.

Remember: In case the physician carries out either mechanical thrombectomy (for instance 37184-+37185, primary, or +37186, secondary), or thrombolysis (for instance 37201, 75896), or both of these, in order to help restore blood flow to the blocked area, CPT says that you might report those services distinctly.

Apply This Territory Rule to Sidestep Denials

The new codes (37220-+37235) are applicable to dissimilar "territories." Each territory has its own individual detailed set of guidelines. Codes 37224-37227 come under the femoral/popliteal vascular territory.

Key rule: CPT denotes that the entire femoral/popliteal territory in one lower extremity thought as a single vessel for CPT reporting."

Accordingly, you must report a single code even though the radiologist carried out several interventions for numerous lesions in the popliteal artery as well as inside the common, deep, and superficial femoral arteries located in the similar leg at the similar session.

71010 and 71020: Look out For Common Documentation Downfalls

Enhance Your X-Ray Services by Understanding Views

A chest X-ray's professional fee is simply $10 or so. Multiply this amount of $10 by the number of services you carry out, however, and you'll then realize how accomplishing these claims right is imperative to your practice's financial health. Read on this expert radiology medical coding article and take a step closer towards accurate and profitable radiology coding.

Actually, 71010 (Radiologic examination, chest; single view, frontal) as well as 71020 (Radiologic examination, chest, 2 views, frontal and lateral) come second and third on the list of the topmost 10 codes radiologists described to the CMS database.

Below, you'll find 71010 and 71020 basics, with example services, typical supporting diagnosis codes, as well as expert radiology coding advice on sidestepping the most common causes of audit-related denials.

Improve Your X-Ray Services by Understanding Views

Every 71010 or 71020 service might involve simply a few minutes of the radiologist's time. Normally, she makes a rapid review of the patient's history, understands the exam conducted by the technician, dictates and then signs the report, and finally shares the results with the ordering physician.

The important element differentiating 71010 from 71020 is certainly that the first signifies a single "frontal" view and the second signifies two views, "frontal and lateral."

71010: Remember, the documentation process for a 71010 service may denote an "AP view." AP means anterior-posterior, meaning the X-rays goes from the anterior (front) to the posterior (back) of the patient.

You also might find reference to a "PA view" (posterior-anterior), wherein the X-rays pass from the back to the front of the patient. The AP view could be more challenging to read than a PA view as quality issues and the way the heart seems enlarged on an AP view. Therefore, providers often have a preference to the PA view over the AP view.

You normally will find an AP view while the patient is unable to stand for the imaging service. Accordingly, a different term you'll regularly see related to 71010 services is "portable," implying that the tech carries out the X-ray with the help of a portable machine. You might find this mainly for services carried out at bedside for inpatients.

71020: You might find a 71020 service mentioned as a 'PA & Lat.' The abbreviation talks about the PA (posterior-anterior) view as well as the Lat (lateral) view. Lateral implies "side." Normally, the tech will take a left lateral X-ray, implying that the patient's left side is nearer to the film than the right side is. However the ordering physician might request for a right lateral X-ray instead.

For instance: A patient with a history of lung cancer comes with a complaint of fever and shortness of breath. Her oncologist orders PA and lateral X-ray imaging. The interpreting radiologist must report 71020. Keep in mind that you should append modifier 26 only if you're reporting the professional component.