BACKGROUND

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.

DOCUMENTING VIEWS

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.

LANGUAGE USED

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.

SUMMARY

• 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

wblock@streamlinemd.com

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