Accurate Documentation for Proper Coding

Always specify the radiopharmaceutical used in the Lasix renal scan. Clearly document the patient’s pre – and post-Lasix images, noting any abnormalities or delayed excretion. Include quantitative data such as glomerular filtration rate (GFR) estimations or differential renal function percentages when available and appropriate. This precision ensures accurate CPT code selection and reimbursement.

Specific Documentation Points

Note the type of imaging modality (e. g., SPECT, planar). Document the administration route and dosage of Lasix. Clearly describe the findings. For example, instead of writing “abnormal scan,” describe the specific abnormalities observed, such as delayed uptake in one kidney, or evidence of obstruction.

Example Table of Documentation

Maintaining detailed and precise documentation simplifies the coding process and minimizes the risk of claim denials. Accurate descriptions help ensure appropriate payment for services rendered.