Incidental Findings
Incidental findings should never be listed as primary diagnoses. If reported, incidental findings may be reported as secondary diagnoses by the physician interpreting the diagnostic test.
Example 1: A patient is referred to a radiologist for an abdominal ultrasound due to jaundice. After review of the ultrasound, the interpreting physician discovers that the patient has an aortic aneurysm. The interpreting physician reports jaundice as the primary diagnosis and may report the aortic aneurysm as a secondary diagnosis because it is an incidental finding.
Example 2: A patient is referred to a radiologist for a chest X-ray because of wheezing. The X-ray is normal except for scoliosis and degenerative joint disease of the thoracic spine. The interpreting physician reports wheezing as the primary diagnosis since it was the reason for the patient’s visit and may report the other findings (scoliosis and degenerative joint disease of the thoracic spine) as additional diagnoses.
Example 3: A patient is referred to a radiologist for an MRI of the lumbar spine with a diagnosis of L4 radiculopathy. The MRI reveals degenerative joint disease at L1 and L2. The radiologist reports radiculopathy as the primary diagnosis and may report degenerative joint disease of the spine as an additional diagnosis.
Incidental/Integral Services
An incidental/integral procedure is performed at the same time as a more complex primary procedure.
Example
The patient is seen for treatment of premalignant lesions.
Incomplete Billing Complete BillingDiagnosis 216.6 (Benign neoplasm of skin of upper limb, including shoulder)
216.6 (Benign neoplasm of skin of upper limb, including shoulder) Code 17004 Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical currettement), premalignant lesions (eg, actinic keratoses),15 or more lesions
17000 Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical currettement), premalignant
lesions (eg, actinic keratoses);
first lesion
17004
Note: Anthem Blue Cross commonly sees incomplete coding examples for incidental edits as indicated above from dermatologists.
Mutually Exclusive
A mutually exclusive edit identifies combinations of procedures that differ in technique or approach but lead to the same outcome.
Example
Patient is seen in the office abdominal pain and swelling.
Incomplete Billing Complete Billing
Diagnosis 682.2 (Abscess of abdominal wall)
789.0 (Abdominal pain)
682.2 (Abscess of abdominal wall)
789.0 (Abdominal pain)
Code 76705 Ultrasound abdominal, real time with image documentation; limited (e g, single organ, quadrant, follow up)
75989 Radiological guidance (eg, fluoroscopy, ultrasound, or computed tomography), for percutaneous drainage (eg, abscess, specimen collection), with placement of catheter radiological supervision and interpretation.
76705-59
75989
Note: Anthem Blue Cross commonly sees incomplete coding examples for mutually exclusive edits as indicated above from the following specialties: Radiologists and primary care physicians.
