decisionhealth Newsletters, Part B News - 2018 Issue 4 (April)
OK to bill view of asymptomatic knee, but code and document properly
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Article Overview
This premium article addresses a common outpatient radiology coding question involving knee X-rays and whether additional views of an asymptomatic side may be reported. It explains the relevance of documentation, medical necessity, and coding specificity, and references guidance from CMS, ICD-10-CM official guidelines, and AHA Coding Clinic. It is aimed at coders, billing staff, and compliance professionals who need to understand how to document and support imaging claims without overstepping policy.
Why This Topic Matters
Proper reporting of diagnostic imaging depends on matching the billed service to the documented exam and on supporting the need for the study. The article helps readers evaluate when radiology documentation, diagnosis coding, and payer expectations may affect claim acceptance.
Article Sections
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Question
Introduces a billing scenario involving knee radiology and the reporting of views when one side is the primary reason for the exam. The section frames the compliance and documentation concern raised by the reader.
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Answer
Summarizes expert commentary on how the imaging service is viewed from a coding and documentation standpoint. It also discusses general medical necessity and references coding guidance sources relevant to the scenario.
What You Will Learn
- How knee radiology reporting is discussed in relation to the number of views performed
- Why documentation and medical necessity matter for imaging claims
- Which general guidance sources are referenced for diagnosis specificity and encounter reporting
- How payer review concerns can influence support for diagnostic imaging services
Who Should Read This
- Medical coders
- Radiology billing staff
- Compliance professionals
- Physician practice managers
- Clinical documentation specialists
Codes Discussed
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