Back in CY 2000, the Department of Health and Human Services designated the CPT code set as the national coding standard for physician and other health care professional services and procedures under the Health Insurance Portability and Accountability Act (HIPAA). As such, the CPT code set is used for all financial and administrative health care transactions sent electronically. Therefore, the Radiologist’s documentation must match the code description in order to assign the CPT code.
Most diagnostic plain film studies have corresponding CPT codes based on the anatomic site and the number of views read. CPT codes are assigned based on the Radiologist’s documentation.
TYPES AND NUMBERS OF VIEWS MAY NEED MODIFICATION FOR CLINICAL REASONS
The number of views for each study is determined based on routine circumstances. However, not every case is routine and may require modification of the recommended number of views. This is one reason why there may not be an exact match between the study ordered and the study performed. Remember, the CPT code should only be assigned based on what you did rather than only what was ordered. The coder reads every report carefully and entirely to determine the correct code(s) to assign.
REIMBURSEMENT IS DETERMINED IN PART BY THE NUMBER OF VIEWS READ
Work RVUs play a major part in determining your reimbursement. Work RVUs are calculated based on estimated time and effort expended by the Radiologist to perform a procedure. The higher the Work RVUs, the higher the reimbursement. More views typically generate higher Work RVUs and reimbursement. In the examples below, notice the correlation between the Work RVUs relative to the number of views.
WORK RVUs ASSOCIATED WITH VIEWS
CPT WORK RVUs CODE DESCRIPTION
70140 0.19 Radiologic examination, facial bones; less than 3 views
70150 0.26 …complete, minimum of 3 views
73560 0.16 Radiologic examination, knee; 1 or two views
73562 0.18 …3 views
73564 0.22 …complete, 4 or more views
73565 0.16 …both knees, standing, anteroposterior
72020 0.15 Radiologic examination, spine, single view, specify level
72040 0.22 …cervical; 2 or 3 views
72050 0.31 …4 or 5 views
72052 0.36 …6 or more views
72100 0.22 Radiologic examination, spine, lumbosacral; 2 or 3 views
72110 0.31 …minimum of 4 views
72114 0.32 …complete, including bending views, minimum of 6 views
72120 0.22 …bending views only, 2 or 3 views
HOSPITAL-GENERATED REPORT TITLES CAN BE MISLEADING – SO DON’T RELY ON THEM
Keep in mind hospital report titles are often generated based on what was ordered and may not always reflect the actual study performed as views are often modified for clinical reasons. If necessary, the Radiologist should correct the report title to capture precisely what was done, not just what was ordered. And finally, before finalizing the report, make sure the report title, the body of reporting and impression are uniform.
Radiologists must consider their audience as they document, and the specific language used in the documentation matters. The Radiologist’s report is not only read by the ordering physician, but also an extended financial audience (e.g., coders, auditors, and payers), all of whom are looking for an exact match between your documentation and formal CPT descriptions. Use language that mirrors CPT. Don’t give insurance companies any excuse to pay less for what was performed.
DO NOT EXCHANGE THE WORD “FILM” FOR “VIEW”
Often due to anatomy, more films are needed to complete the study. Radiologists must remember that the number of views count for coding purposes. It doesn’t matter if 1 film or 100 films of the same view were obtained – it still only counts as 1 view. Follow the guidelines and don’t name another Film as a View unless it is truly another View.
- CPT codes and their descriptions are the standards that need to be followed
- Code assignments are based on Radiologist documentation
- The financial audience is looking for a match between the Radiologist’s documentation and the codes assigned
- Always document the number/types of views read – Don’t rely on the report titles
- Understand the difference between Views and Films – Never exchange the word “film” for “view”
Wendy Block, CPC, RCC, CIRCC
Senior Coding Advisor, StreamlineMD
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