THE CODING SEMINAR, PRESENTED BY APMA

Saturday, March 30, 2019 Boston, MA

Michael G. Warshaw, DPM, CPC

ICD-10 AND CPT CODING FOR IMAGING SERVICES

Written Reports

• Per the CPT Manual: “A written report (eg. handwritten or electronic) signed by the interpreting individual should be considered an integral part of a radiological procedure or interpretation.”

Radiographs/X-rays

Appropriate Documentation For An X-ray Report

• 1. State the actual views that were obtained. • 2. Document a general overview of the X-rays that

were obtained. Certainly there are other • identifiable issues present in addition to the diagnosis

that you ordered the X-rays for. • 3. "Target the Diagnosis." Whenever X-rays are

obtained, there is a diagnosis code that is used to • not only justify obtaining the X-rays, but also to bill

for those X-rays. Wouldn't it behoove you to • make mention of that diagnosis in the X-ray report?

Modifiers 26 Modifier Professional component only Use this modifier if you are only billing for the physician component of the X-ray service (ie. The interpretation of the radiographs and the generation of a report) TC Modifier Technical component only Use this modifier if you are only billing for the technical component of the X-ray service (ie. The obtaining of the radiographs and the developing or processing of the radiographs) If the provider is performing both the professional and the technical components of the X-ray service, a modifier is not utilized aside from the anatomical modifier

The CPT Codes

• 73600 Radiologic examination, ankle; 2 views • 73610 complete, minimum of 3 views • 73620 Radiologic examination, foot; 2 views • 73630 complete, minimum of 3 views • 73650 Radiologic examination; calcaneus,

minimum of 2 views • 73660 toe(s), minimum of 2 views

DIAGNOSTIC ULTRASOUND

76881

• Ultrasound, complete joint (ie. joint space and periarticular soft tissue structures), real-time with image documentation

• This is a real time scan of a specific joint to include all of the following: muscles, tendons, joints, other soft tissue structures, and any other abnormality. The examination would include multiple views of the area being examined and both static and dynamic images (the latter when warranted)

76882

• Ultrasound, extremity, nonvascular, real time with image documentation; limited, anatomic specific

• A limited evaluation of a joint or an evaluation of a specific anatomical structure other than a joint (eg. Soft tissue mass)

• Both CPT codes 76881 and 76882 require permanently recorded images and a written report containing a description of each of the elements evaluated.

DIAGNOSTIC ULTRASOUND, continued

• Evaluation of the following 3 soft tissue deformities may not require diagnostic ultrasound evaluation:

• 1. clinically obvious ganglion cysts • 2. plantar fascia in cases of plantar fasciitis • 3. Morton’s neuromas • *Please read the LCD of the respective

Medicare carrier to determine what is considered to be medically necessary

DIAGNOSTIC ULTRASOUND, continued

• 76942: Ultrasound guidance for needle placement (eg biopsy, aspiration, injection, localization device), imaging supervision and interpretation

• NOTE: Be careful with this code, especially with ultrasound guided injections

The Use of Ultrasound Guided Injections of the Foot and Ankle

• 20600 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg. Fingers, toes); without ultrasound guidance

• 20604 with ultrasound guidance, with permanent recording and reporting

• 20605 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg. Temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance

• 20606 with ultrasound guidance, with permanent recording and reporting

Magnetic Resonance Imaging

• 73718 Magnetic resonance (eg. proton) imaging, lower extremity other than joint; without contract material(s)

• 73719 with contrast material(s)

• 73721 Magnetic resonance (eg. proton) imaging, any joint of lower extremity; without contrast material(s)

• 73723 with contrast material(s)

Fluoroscopy

• 76000 Fluoroscopy (separate procedure), up to 1 hour physician or other qualified health care professional time

• 77022 Fluoroscopic guidance for needle placement (eg. Biopsy, aspiration, injection, localization device) (List separately in addition to code for primary procedure)

Questions?

Thank You So Much!!!