Decoding the Disconnect: Avoiding Common ICD-10 Pitfalls in Outpatient Radiology Coding

Radiology reports are inherently detailed—packed with nuanced observations, anatomical precision, and incidental discoveries. However, this depth of information doesn’t always translate seamlessly into ICD-10-CM codes, especially in the outpatient setting where stricter coding rules apply.

At Bristol, our extensive experience with radiology practices and coding teams has revealed a persistent challenge we call the Radiology ICD-10 Disconnect. This disconnect often leads to revenue leakage, compliance issues, and an increased risk of audits. Let’s explore how these pitfalls occur—and more importantly, how to avoid them.

A Common Outpatient Coding Scenario: A Lesson in Misinterpretation

Consider this radiology impression:

“Findings suggestive of early pneumonia. Recommend clinical correlation.”

What’s often coded?

J18.9 – Pneumonia, unspecified organism

What’s the issue?

This code represents a definitive diagnosis, yet the radiologist’s phrasing—“suggestive of”—does not confirm pneumonia. According to ICD-10-CM Outpatient Coding Guidelines, Section IV.H, conditions described as probable, suspected, questionable, or consistent with should not be coded as established diagnoses in outpatient settings.

The correct approach? Code the most certain finding:

R91.8 – Other nonspecific abnormal finding of lung field

This more accurately reflects the imaging result and complies with coding guidelines, reducing the risk of payer denials or retrospective audit penalties.

Three Key Disconnects That Undermine Radiology Coding Accuracy

1. Ambiguous or Suggestive Language Mistaken for Confirmed Diagnoses

Radiologists often use terms such as “likely,” “possible,” “cannot exclude,” or “suspicious for”—especially when clinical correlation is recommended. Unfortunately, these phrases are frequently interpreted as confirmed diagnoses.

ICD-10 Guideline IV.D allows for the use of signs and symptoms codes when no definitive diagnosis has been made. For example:

• A radiology report notes “cannot rule out diverticulitis.”
• The coder should not assign K57.30 (Diverticulitis) but instead report a symptom-based code like R10.9 (Unspecified abdominal pain) if that’s what prompted the scan.

Pro Tip: Train coders to look beyond impressions and evaluate the language used. If a condition isn’t stated definitively, it must not be coded as such.

2. Under-Coding Due to Missed Specificity in Reports

Despite radiology reports often including specific details—such as laterality, location, extent of disease, or presence of medical devices—many coders still default to unspecified codes. This violates Guideline IV.F.3, which mandates coding to the highest level of specificity supported by documentation.

For Example:

• Report: “Right rotator cuff tear, full thickness.”
• Incorrect: M75.10 – Unspecified rotator cuff tear or rupture
• Correct: M75.121 – Complete rotator cuff tear or rupture of right shoulder, not specified as traumatic

Pro Tip: Build tools or checklists into the workflow to help coders extract laterality, chronicity, and anatomical detail. Coding specificity not only improves claims accuracy but also supports better data for risk adjustment and reporting.

3. Incidental Findings: To Code or Not to Code?

Radiologists are trained to document everything they see—even if it isn’t related to the original reason for the study. But when it comes to coding, not every incidental finding belongs on the claim.

Per Guideline IV.K, only those findings confirmed by the interpreting physician and relevant to the reason for the test should be coded. Symptoms should be reported only if they’re unrelated and clinically significant.

For Example:

• A CT ordered for suspected appendicitis notes: “Incidental renal cyst; recommend follow-up.”
• If the renal cyst has no bearing on the reason for the test and no clinical correlation is documented, it should not be coded—unless payer policy or documentation warrants it.

Pro Tip: Develop internal criteria or coder checklists for evaluating the reportability of incidental findings. When in doubt, query the radiologist.

Why Getting It Right Matters: The Ripple Effect of Poor Coding

The consequences of radiology coding errors go far beyond claim rejections. The disconnect can:

• Trigger payer denials due to lack of medical necessity or mismatch with LCD/NCD guidelines
• Distort risk adjustment scores for value-based contracts
• Invite payer audits and potential recoupments
• Skew quality metrics and reporting, impacting star ratings and reimbursement

In short, getting the ICD-10 coding right in outpatient imaging is not optional—it’s essential to both operational integrity and financial health.

Proven Strategies to Bridge the ICD-10 Gap in Radiology Coding

Here’s how your coding team can stay compliant and accurate:

Always Review the Full Report

The impression section alone may lack context. Review the entire body of the radiology report to extract key clinical clues, terminology, and supporting findings.

Code with Precision

Use all available details—laterality, chronicity, underlying conditions—to assign the most specific ICD-10 code. Avoid “NOS” (not otherwise specified) or “unspecified” unless absolutely necessary.

Implement Strong Query Protocols

When documentation is unclear, query the radiologist for clarification. Timely and consistent communication ensures alignment and defensibility during audits.

Foster Collaboration Between Coders and Radiologists

Host periodic training or feedback sessions to align on documentation best practices. Educating radiologists on how coding decisions are made encourages clearer documentation.

Adhere Strictly to ICD-10 Outpatient Guidelines

Coders should be well-versed in Section IV of the ICD-10-CM guidelines and revisit updates annually. Keeping current ensures ongoing compliance and accuracy.

Conclusion: Precision Coding Starts with Documentation Awareness

Radiology coding is not a mechanical task—it’s an exercise in translating detailed clinical narratives into compliant, specific ICD-10 language. In outpatient imaging, where rules are stricter and payer scrutiny is higher, avoiding the ICD-10 disconnect is critical.

Coders must become expert interpreters—not just of medical reports, but of the guidelines that govern them. When we code with accuracy, specificity, and context in mind, we:

• Improve claim acceptance rates
• Support correct reimbursement
• Strengthen compliance posture
• And ultimately, tell the full story of the patient’s care

By closing the gap between what’s seen on the scan and what’s documented on the claim, we can elevate the integrity of outpatient radiology coding—one compliant code at a time.

Partner with Experts Who Understand Radiology Inside and Out

At Bristol, we understand the unique coding challenges that radiology practices face—especially in the high-stakes outpatient diagnostic imaging environment. Our Radiology coding services are designed to bridge the disconnect between clinical documentation and compliant, accurate ICD-10 coding.

With a team of certified coding specialists who are extensively trained in radiology-specific coding guidelines, we ensure:

• 100% adherence to ICD-10-CM outpatient guidelines
• Precise abstraction of findings from complex reports—beyond the impression
• Code selection at the highest level of specificity
• Expert handling of incidental findings and ambiguous language
• Seamless integration with your existing workflows and EMR systems
• Faster turnaround times and improved first-pass claim acceptance rates

We don’t just code—we collaborate. Our team works closely with your radiologists and clinical staff to align on terminology, reduce ambiguity, and improve documentation quality, leading to fewer denials and enhanced revenue integrity.

Whether you're a stand-alone imaging center or part of a large multi-site practice, Bristol’s Radiology Coding Services help you stay compliant, audit-ready, and financially strong.

Let’s Get Your Coding Right—Every Time

Get in touch with us today to learn how our radiology coding solutions can elevate your practice’s performance and protect your bottom line!