AMA Clinical Examples in Radiology - 2017 Issue 3 (Summer)
Questions and Answers
QUESTIONS AND ANSWERS Question Answer Five doctors who are hospital-based radiologists are in our practice. We bill separately using the 26 modifier for the services we provide at each facility. One hospital asked us if an unsigned order from the referring physician would affect billing and reimbursement for the radiologist. Can you answer this question? Hospital facilities are regulated through the accreditation process of the Joint Commission and are covered under Centers for Medicare & Medicaid Services 42 Code of Federal Regulations 482.26 (b) (4), Conditions of Participation: Radiologic Services. Medicare's conditions of participation state that "radiologic services...
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Article Overview
This Q&A article discusses practical radiology coding and documentation topics for hospital-based and nonhospital settings. It covers ordering requirements, catheterization reporting, image-guided aspiration, and obstetric ultrasound documentation and code selection considerations. The piece is aimed at radiology coders, billing staff, and physicians who need to understand how current guidance and policy sources affect reporting.
Why This Topic Matters
Readers can use this article to understand how radiology documentation, ordering, and procedure classification issues are discussed in coding guidance sources. It is especially relevant when evaluating whether a study or service should be reported under a particular radiology code family and what supporting documentation is expected.
Article Sections
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Hospital ordering requirements and nonhospital diagnostic test orders
Discusses questions about unsigned orders, hospital participation requirements, and how ordering expectations differ between hospital and nonhospital settings. References Medicare policy and hospital accreditation context.
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Selective catheterization of hepatic segments
Addresses catheterization reporting for separate vascular branches in the liver and the general radiology code families involved. The discussion focuses on whether distinct segmental selections are treated separately.
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Drainage of breast abscess or seroma without catheter placement
Covers a procedure question about reporting percutaneous drainage of a breast fluid collection when no catheter remains in place. Also discusses the associated imaging guidance approach and related coding context.
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Obstetrical ultrasound code 76811
Explores documentation and coding considerations for detailed obstetrical ultrasound reporting. The section references professional guidance, medical necessity documentation, and the relationship between anatomy, indication, and code selection.
What You Will Learn
- How radiology ordering requirements differ in hospital and nonhospital settings
- How selective catheterization questions are discussed for hepatic arterial branches
- How image-guided breast aspiration questions are framed in coding guidance
- What documentation themes are associated with detailed obstetrical ultrasound reporting
- Which professional and policy sources are cited in support of the Q&A guidance
Who Should Read This
- Radiology coders
- Hospital billing staff
- Physicians and radiologists
- Coding educators
- Revenue cycle professionals
Codes Discussed
Modifiers Discussed
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