Unlike other specialties, Radiology coding isn’t for the faint-hearted. It’s a space where small mistakes turn into big denials, and the rules feel like they’re rewritten again and again by payers. By 2025, things haven’t exactly gotten simpler. Code updates, payer edits, bundling changes, it’s all still happening. But with the right approach, the most common issues can be avoided without burning out. Here’s a practical look at what’s working in radiology coding this year, and what’s not.
1. Stick to What Was Actually Done, Not What Was Ordered
One of the biggest mistakes? Coding what was ordered, not what was performed. Just because the order said “CT with contrast” doesn’t mean that’s what the tech did. If the contrast wasn’t administered, or it turned into a non-contrast study, code it as such. It’s not about intention, it’s about action.
Quick reminder:
In radiology, “contrast” = IV contrast. Not oral. Not rectal. That confuses a lot of coders, especially when reports casually mention contrast without specifics.
2. The Order Drives the Diagnosis Code, Don’t Let Findings Lead the Way
If the exam was done for back pain, that’s your primary diagnosis, even if the report shows a slipped disc, an incidental cyst, or a unicorn. Always connect the diagnosis code back to the reason for the exam.
Common pitfall:
Coding every finding, even if it had nothing to do with the patient’s symptoms. Unless the radiologist suggests follow-up or says it’s clinically significant, don’t list it just because it’s there.
3. Know Your Components: Global, Professional, and Technical
This one’s been around forever, but still gets botched. Global means the full service (tech + interpretation). Modifier TC is for the technical side only (machine, staff, room). Modifier 26 is for the professional side only (the doc’s read).
Mistake to avoid:
Billing the global code when only the read was done. Or applying 26 automatically when a group owns both the equipment and the reading.
Always check:
- Who owns the machine?
- Who read the scan?
- What location is listed?
4. Don’t Guess When It Comes to Bundled Services
CTs come with scout films. Fluoroscopy is often baked into interventional procedures. A lot of what shows up in a report doesn’t mean it’s separately billable. Unbundling is one of the quickest ways to draw unwanted attention, especially from payers and auditors.
Best move:
Check the NCCI edits every time you code a combo. They’re not just suggestions, they’re rules.
5. Modifiers Matter, But Use Them Wisely
Modifiers like 76, 77, 59, and 91 can save a claim, or wreck it. They exist for a reason, but when they’re overused or applied blindly, they cause more harm than good.
A quick rundown:
- 76: Repeat procedure by the same provider
- 77: Repeat by a different provider
- 59: Separate service, different session or site (use as a last resort)
- 91: Repeat lab or diagnostic test, same day
Before applying any of them, make sure the report explains why the repeat happened and what changed.
6. Don’t Let Templates Do the Coding for You
Yes, EHRs make things faster. But speed isn’t accuracy. Relying too much on templates, auto-populated fields, or preloaded code sets leads to errors. Especially when radiologists copy-paste findings or reuse old templates.
Tip:
Give reports a human check. Don’t assume the codes in the system are right just because they’ve been there for months. If something feels off, it probably is.
7. Stay on Top of Annual Code Updates
2025 brought a few quiet but important changes in radiology coding. Some bundled services, some reworded descriptions, and some new codes altogether. If your cheat sheets haven’t been updated since last year, it’s time to create a new one.
Solid habit:
Review the CPT code updates every January. Even better, subscribe to CPT Assistant or ACR updates, they break it down without the jargon.
8. Interventional Radiology Coding Is Its Own Beast
If you’re working with IR procedures, double everything: double the time, double the attention, and double the documentation review. The coding involves catheter placements, imaging guidance, therapeutic procedures, and everything has its own code set and modifiers.
Common trip-up:
Missing the selective catheter level or coding the diagnostic angiogram without confirming it’s truly billable during an intervention.
Advice:
Break down the op note into steps: access, imaging, intervention, closure. Code each part as documented, not assumed.
9. Audit Your Own Work Like You Didn’t Do It
It sounds weird, but one of the best habits in radiology coding is doing a quick self-audit before final submission. Ask:
- Do the diagnosis codes match the order?
- Is the CPT code supported by what’s written in the report?
- Are the modifiers needed, and correct?
Bonus move:
Pick five random claims a week and review them like you’re the payer. You’ll start catching patterns and tightening up accuracy.
10. Talk to Your Radiologists
A lot of issues in radiology coding come down to unclear documentation. If the report is vague, ‘possible contrast,’ ‘non-specific findings,’ ‘normal’, ask for clarification. Not everything needs a formal query. Sometimes, just a quick message helps the doctor clean up their future dictation.
Reality check:
Radiologists are busy. Coders are busy. But if both sides talk more, claims go out cleaner and get paid faster. Win-win.
At the end of the day, radiology coding is about being sharp, not fast. Coders who take shortcuts may get claims out the door, but they’ll come right back as denials or audits. Coders who stay updated, double-check, and keep their logic tight are the ones keeping their practices running smooth.
