Please review our radiology coding compliance example and let us know if you have any questions. |
| Physician |
Patient |
Original
RBRVS Units |
TCN's
RBRVS Units |
Difference |
% |
Missed
Procedure |
Billed
for Services Not Supported |
Wrong
Code |
Modifier |
Ordering |
DX |
Dictation |
| Edwards |
1 |
75.44 |
75.24 |
-20 |
1 |
XX |
X |
|
XX |
XX |
|
X |
| Robertson |
2 |
7.53 |
8.04 |
.51 |
7 |
|
|
X |
XX |
|
X |
|
| Edwards |
3 |
13.71 |
14.73 |
1.02 |
7 |
XX |
|
|
XX |
XX |
XX |
|
| Edwards |
4 |
80.00 |
80.17 |
.17 |
1 |
XX |
XX |
XX |
XX |
XX |
|
|
| Edwards |
5 |
8.00 |
6.37 |
-1.63 |
2 |
X |
|
X |
|
|
X |
|
| Frank |
6 |
17.96 |
9.73 |
8.23 |
46 |
XX |
|
XX |
|
|
|
|
| Edwards |
7 |
8.82 |
10.36 |
1.54 |
17 |
XX |
|
X |
X |
XX |
X |
|
| Kramer |
8 |
43.24 |
43.24 |
0 |
0 |
|
|
|
X |
|
|
|
| Kramer |
9 |
30.61 |
20.55 |
-10.06 |
33 |
XX |
XXX |
X |
X |
XX |
X |
|
| Edwards |
10 |
2.59 |
2.59 |
0 |
0 |
|
|
|
X |
|
|
|
| Positive
percentage difference means original coding overvalued the case. |
|
| Patient:
1 |
DOS:
02/15/02 |
Doctor:
White |
Original
Codes
36145
36145-59
36870
35476
35476-59
75978-26
75790-26
(not supported)
75820-26 |
RVU's
2.81
2.81
47.02
9.25
9.25
.75
2.57
.98 |
Total
RVU's 75.44
|
|
The
Coding
Network's Codes
36870
(90 day global)
35476-51
75978-26
35476-59
75978-26-59 (missed
code)
36145-51
36145-59
75710-26
(missed code)
75820-26 |
RVU's
47.02
9.25
.75
9.25
.75
2.81
2.81
1.62
.98 |
Total RVU's 75.24 |
|
Discussion:
- Order:
Always pair up surgical codes with corresponding
S & I codes when appropriate.
-
Modifier:
51 not indicated for multiple procedures.
- Missed
code: 75978 indicated twice to represent the 2nd
S&I for the 2nd PTA.
- Missed
code:
Dictation indicates an retrograde arteriogram above the
arterial anastomosis, added S&I code 75710-26
- Ordering:
Surgical procedures not indicated in order of descending
value.
- Dictation:
Operative
report not clear as to the S&I component for a fistulagram
which would be represented with code 75790. We did not indicate
as we could not identify in the dictation.
|
| Diagnoses:
996.73
Complication of dialysis graft
585 Renal failure |
Diagnoses:
996.73
Complication of dialysis graft
585 Renal failure |
Discussion:
|
|
| Patient:
2 |
DOS:
2/21/02 |
Doctor:
Robertson |
Original
Codes
76000-26
(wrong code)
36489-78-LT |
RVU's
.25
7.28 |
Total
RVU's 7.53
|
|
The
Coding
Network's Codes
36489-78
76003-78/26 |
RVU's
7.28
.76 |
Total RVU's 8.04 |
|
Discussion:
- Wrong
Code: Fluoroscopic guidance for insertion of CV-
line is to be represented by the use of code 76003 which
was created for the purpose of identifying the fluro guidance.
The use of 76000 is in appropriate.
- Missed
Modifier: Per the dictation, the patient is in
post op status from the day prior. Modifier –78 should
be applied to all procedures during the operative session
which are related.
- Modifier:
Modifier –RT/LT is not necessary for CV lines placed
in the jugular vein of the neck as the anatomical site of
the cervical area is not considered bilateral.
|
| Diagnoses:
585 Renal
Failure |
Diagnoses:
996.73
Complication of dialysis graft
585 Renal failure |
Discussion:
- All
pertinent diagnoses were not utilized.
|
|
| Patient:
3 |
DOS:
02/12/02 |
Doctor:
Edwards |
Original
Codes
36140-59
36246
75625-26
75716-26 |
RVU's
2.82
7.45
1.60
1.84 |
Total
RVU's 13.71
|
|
The
Coding
Network's Codes
36246-RT
75774-26-RT (missed
code)
36140-LT-59
75774-26-LT (missed
code)
75716-26
75625-26 |
RVU's
7.45
.51
2.82
.51
1.84
1.60 |
Total RVU's 14.73 |
|
Discussion:
- Order:
Always pair up surgical codes with corresponding
S & I codes when appropriate.
- Order:
Always list codes with the highest RVU first.
- Missed
Codes: 75774 should be charged for LT and RT external
iliac imaging.
- Modifiers:
The use of RT & LT is essential for clarification when
coding bilateral vessels.
|
| Diagnoses:
440.20
Artherosclerosis of extremities, unspecified.
447.1 Stricture of artery |
Diagnoses:
447.1
Iliac stenosis
440.1 Renal stenosis
440.24 Artherosclerosis with gangrene |
Discussion:
- All
pertinent diagnoses were not utilized.
- Dictation
provided information to code diagnoses to a higher level
of clarification and/or specificity.
|
|
| Patient:
4 |
DOS:
02/12/02 |
Doctor:
Edwards |
Original
Codes
36145
36145-59
36010 (not done)
36870
35476
35476-59 (wrong
code)
75978-26
75964-26
(wrong code)
75790-26
75825-26 (not done) |
RVU's
2.81
2.81
3.43
47.02
9.25
9.25
.75
.51
2.57
1.60 |
Total
RVU's 80.00
|
|
The
Coding
Network's Codes
36870
35475-51 (missed)
75962-26 (missed)
35476-51
75978-26
36145-51
36145-59
75790-26 |
RVU's
47.02
14.19
0.77
9.25
.75
2.81
2.81
2.57
|
Total RVU's 80.17 |
|
Discussion:
- Order:
Always pair up surgical codes with corresponding S &
I codes when appropriate.
- Order:
Always list codes with the highest RVU first.
- Wrong
Code: Dictation reflects a PTA of both the arterial and
venous limb of the AV-Fistula. Original coding identified
the venous limb twice which is incorrect. We exchanged the
second 35476/75978 for 35475/75962 to represent the arterial
side.
- Modifier:
-51 should be added to surgical codes that are not the primary
procedure.
- Procedures
not Performed: 36010 and 75825 were not done. Reviewing
the dictation the surgeon indicates a fistulogram which
included an image of the vena cava which is consistant with
procedure code 75790. Selection of the vena cava was not
done. The catheter was never placed beyond the AV-Fistula.
- Wrong
codes: 75964 is for an additional arterial PTA and not the
initial arterial PTA. We exchanged 75964 for 75962 for this
reason.
|
| Diagnoses:
996.73
Complication of dialysis graft
585 Renal failure |
Diagnoses:
996.73 Complication
of dialysis graft
585 Renal failure |
Discussion:
|
|
