Radiology Compliance Question of the Week
Archive

October 14, 2013

Question
We often have patients with existing ports present to the department for contrast exams. Our radiology nurse flushes the port prior to the contrast injection. Can CPT code 96368 be assigned in conjunction with a contrast study? I do not see any CCI edits but want to make sure.

Answer
No, Flushing a catheter/port prior to drug delivery (including contrast) is considered an inherent part of the process and, therefore, should not be coded separately. Code 96368 is not used to report a flush but an intravenous infusion (for therapy, prophylaxis,ds or diagnosis). It is also an add-on code to 96365, 96366, 96413, 96415, and 96416, none of which would be coded during imaging exams. Code 96523 (irrigation of implanted venous access device for drug delivery systems) is available for routine flushing of a catheter, but it can only be assigned if that is the only service provided as noted in a CPT parenthetical note.



October 7, 2013

Question
The description for CPT code 70336 reads as “magnetic resonance (e.g., proton) imaging, temporomandibular joint(s).” Does this mean that the same CPT code would be assigned for unilateral and/or bilateral TMJs? If so, is a modifier required to differentiate left from right?

Answer
Code 70336 is assigned once whether imaging is performed on one side or both sides. Modifiers are not necessary if a unilateral study is done—unless a payer requires it. Do not code separately as 70336-RT and 70336-LT.



April 8, 2013

Question
Would you agree that when doing an AP view of the abdomen with an oblique view that code 74010-52 would be assigned, or would you code 74000 to the lowest specificity?

Answer
I agree with your coding choice 74010-52 for AP and oblique abdominal x-rays. Clinical Examples in Radiology, Summer 2011, includes a Q & A concerning this.



April 1, 2013

Question
Is there a way to code for repositioning of an (inferior vena cava) IVC filter?

Answer
Beginning January 1, 2012, there are three new codes: IVC filter placement (37191), repositioning (37192), and removal (37193). These are complete codes that include all the work involved. You would not code separately for catheterization, injections of contrast, or imaging.



March 25, 2013

Question
If we do only two bending views of the lumbar spine, do I code 72100 or 72120-52?

Answer
As of January 1, 2012, you would code 72120 (without modifier 52). CPT code 72120 was revised for 2012. Instead of four bending views, this code now specifies two or three views.



March 18, 2013

Question
Does the new CTA combination code include chest, or only abdomen and pelvis?

Answer
Code 74174 (effective January 1, 2012) includes only abdomen and pelvis CTA when performed at the same session. The individual codes (74175 and 72191) remain for times when only one of these areas is examined. If a CTA chest is also performed, code 71275 separately.



March 11, 2013

Question
What are correct CPT codes to assign when a magnetic resonance imaging (MRI) arthrogram is performed? Would the shoulder MRI arthrogram be assigned (73222–MRI shoulder w/contrast) and 73040 (fluoroscopy for joint injection)?

Answer
It depends on the procedure actually performed.

If a true diagnostic radiographic arthrogram was done prior to an MRI then you would assign the following codes: 23350, 73040, and 73222. However, most of the time a true radiographic arthrogram is not performed, and it is instead an injection under fluoro guidance and then the MRI. An image or two might be taken to confirm needle and contrast location, but a true diagnostic arthrogram is not done. In this case, you would assign the following: 23350, 77002, and 73222.



March 4, 2013

Question
CPT Code 0238T is no longer covered under our Florida local coverage determination (LCD). What code can we use now?

Answer
Unfortunately, if you are doing an iliac atherectomy, you must code 0238T because it is still a valid code. Florida Medicare will not pay for the service, but since it deems it a “non-covered” service, you may have the patient sign an advanced beneficiary notice (ABN) and can bill the patient for the service. If the patient chooses not to sign the ABN or if you fail to ask for an ABN signature and perform the service anyway, then you cannot bill the patient.

Since you are allowed to code the catheterization codes with 0238T, you may get payment for those, but that is not certain as Medicare can decide not to pay those codes since they were done in conjunction with a non-covered service. Other payers may cover 0238T, but you should check before performing the service.



February 18, 2013

Question
We did a computed tomography (CT) triple-phase liver scan, which was coded 74160, and then did a CT pelvis (72194). HCPCS issues a warning that these codes cannot be performed together, but in our case, they were both done together. Are these correct codes to use? If so, should we attach modifier 59?

Answer
There are combined CT abdomen and pelvis codes. When both are done, you do not code the individual codes (74160 and 72194), you would code a combination code. Specifically, assign 74176 when both the abdomen and pelvis are done without contrast. Assign 74177 when both are done with contrast. Code 74178 is assigned for all other combinations.

In your case, since the abdomen was with contrast (74160), and the pelvis was without and with contrast (72194), then you would assign 74178.



February 11, 2013

Question
Can you tell me if CPT 49423 includes the catheter (C1729) for outpatient hospital billing? How would I find this out? Is there a list of procedures that include supplies available?

Answer
A procedure-to-device edit requires that you list C1729 when you bill 49423 under the hospital outpatient prospective payment system. There will be no additional payment since C1729 is packaged, but you must show the C code. This is the same as the nuclear medicine edits where you have to add the HCPCS code for the radiopharmaceutical with any nuclear medicine code but you don’t get paid for the diagnostic radiopharmaceutical.

For the current procedure-to-device edits, go to http://www.cms.gov/HospitalOutpatientPPS/02_device_procedure.asp#TopOfPage. To learn more about billing of devices by hospitals, see the following link to the Medicare Claims Processing Manual, Chapter 4, section 61: http://www.cms.gov/manuals/downloads/clm104c04.pdf.



February 4, 2013

Question
What code/s would be assigned for sacroiliac joint (SI) radiofrequency (RF) denervation?

Answer
CPT Assistant, December 2009 said to use code 64999 for this procedure.



January 28, 2013

Question
Would you agree that when doing an AP view of the abdomen with an oblique view that code 74010-52 would be assigned, or would you code 74000 to the lowest specificity?

Answer
I agree with your coding choice 74010-52 for AP and oblique abdominal x-rays. Clinical Examples in Radiology, Summer 2011, includes a Q & A concerning this.



January 21, 2013

Question
During a renal angiogram we saw that the patient had an accessory left renal artery. This artery was subsequently selectively catheterized and imaged. Do we add 36245 for that catheterization?

Answer
Prior to January 2012, that would have been correct. However, in 2012 we have new complete codes for renal angiography. The new codes include all the work of renal angiography, including catheterization and imaging of accessory arteries. Code 36251 is unilateral, first order—left or right main renal artery and any accessory renal artery(s); 36252 is bilateral first order—both main renal arteries and any accessory renal arteries; 36253 is unilateral second order or higher—left or right renal artery branches (including any accessory arteries); 36254 is bilateral second order or higher—second order or higher branches of both renal arteries (including any accessory arteries). Codes 75722 and 75724 have been deleted, and you would not also code 36245.



January 14, 2013

Question
Is there a way to code for repositioning of an (inferior vena cava) IVC filter?

Answer
Beginning January 1, 2012, there are three new codes: IVC filter placement (37191), repositioning (37192), and removal (37193). These are complete codes that include all the work involved. You would not code separately for catheterization, injections of contrast, or imaging.



January 7, 2013

Question
If we do only two bending views of the lumbar spine, do I code 72100 or 72120-52?

Answer
As of January 1, 2012, you would code 72120 (without modifier 52). CPT code 72120 was revised for 2012. Instead of four bending views, this code now specifies two or three views.



December 31, 2012

Question
Does the new CTA combination code include chest, or only abdomen and pelvis?

Answer
Code 74174 (effective January 1, 2012) includes only abdomen and pelvis CTA when performed at the same session. The individual codes (74175 and 72191) remain for times when only one of these areas is examined. If a CTA chest is also performed, code 71275 separately.



 

December 17, 2012

Question
What would be correct CPT coding for ultrasound of the appendix? We had an order for limited abdomen and appendix at the same date of service and wanted to code appropriately.

Answer
There is no specific code for ultrasound of the appendix. According to the American College of Radiology, depending on clinical presentation and order, you could assign 76700 (complete abdomen), 76705 (limited abdomen), or even pelvic ultrasound (76856 or 76857).

In no case would you code 76705 x 2. In your case, your best code would probably be 76705 (once) to include both.


 

December 10, 2012

Question
If a patient has breast implants, should a code for a screening or diagnostic mammogram be assigned?

Answer
You bill for whatever the patient’s doctor ordered. Having implants does not make for a diagnostic mammogram. Without other signs or symptoms of potential breast cancer, it should be a screening exam. If the patient’s doctor orders a diagnostic exam without clinical indications other than implants, you would need to get an advanced beneficiary notice (ABN) if the patient was Medicare (or be prepared to write the charges off). For non-Medicare patients, you would need to check with their insurers to see if a diagnostic exam would be allowed in this case.



December 3, 2012

Question
An emergency department patient has a one-view chest x-ray ordered and performed. Later he has a two-view chest x-ray ordered and performed. Can we code for both?

Answer
Yes, since these are performed at different sessions, you can code for both. Add modifier 59 to 71010.



November 26, 2012

Question
What code would you use for an ultrasound of abscess on the lip?

Answer
Code 76536–soft tissues of head and neck—would be assigned.



November 19, 2012

Question
What are correct CPT codes to assign when a magnetic resonance imaging (MRI) arthrogram is performed? Would the shoulder MRI arthrogram be assigned (73222–MRI shoulder w/contrast) and 73040 (fluoroscopy for joint injection)?

Answer
It depends on the procedure actually performed.

If a true diagnostic radiographic arthrogram was done prior to an MRI then you would assign the following codes: 23350, 73040, and 73222. However, most of the time a true radiographic arthrogram is not performed, and it is instead an injection under fluoro guidance and then the MRI. An image or two might be taken to confirm needle and contrast location, but a true diagnostic arthrogram is not done. In this case, you would assign the following: 23350, 77002, and 73222.



November 12, 2012

Question
CPT Code 0238T is no longer covered under our Florida local coverage determination (LCD). What code can we use now?

Answer
Unfortunately, if you are doing an iliac atherectomy, you must code 0238T because it is still a valid code. Florida Medicare will not pay for the service, but since it deems it a “non-covered” service, you may have the patient sign an advanced beneficiary notice (ABN) and can bill the patient for the service. If the patient chooses not to sign the ABN or if you fail to ask for an ABN signature and perform the service anyway, then you cannot bill the patient.

Since you are allowed to code the catheterization codes with 0238T, you may get payment for those, but that is not certain as Medicare can decide not to pay those codes since they were done in conjunction with a non-covered service. Other payers may cover 0238T, but you should check before performing the service.



November 5, 2012

Question
Would we use 70486 for computed tomography (CT) of the sinuses?

Answer
Yes, code 70486 is the appropriate code for CT of the sinuses.



October 29, 2012

Question
We did a computed tomography (CT) triple-phase liver scan, which was coded 74160, and then did a CT pelvis (72194). HCPCS issues a warning that these codes cannot be performed together, but in our case, they were both done together. Are these correct codes to use? If so, should we attach modifier 59?

Answer
There are combined CT abdomen and pelvis codes. When both are done, you do not code the individual codes (74160 and 72194), you would code a combination code. Specifically, assign 74176 when both the abdomen and pelvis are done without contrast. Assign 74177 when both are done with contrast. Code 74178 is assigned for all other combinations.

I
n your case, since the abdomen was with contrast (74160), and the pelvis was without and with contrast (72194), then you would assign 74178.



October 22, 2012

Question
Can you tell me the CPT code for a computed tomography (CT) scan run-off that covers from T12 to the bottom of the feet?

Answer
If this is not a CT angiogram (CTA), there is not one code. If the abdomen and bilateral lower extremity exams were ordered, medically necessary, and performed, you would assign the individual codes (for example, 74150 and 73700 x 2 if “without contrast” exams were done). If one leg was imaged for comparison, then only one extremity code would be assigned.

If this is a CTA, then 75635 is the appropriate code.



October 15, 2012

Question
I have a question regarding 49083. We perform several ultrasound-guided paracentesis procedures. We recently found, through a national correct coding initiative (CCI) edit, that we can no longer charge for the ultrasound-guided needle placement (76942). Are we allowed to charge for 76705 so that we can at least try to recoup for the ultrasound portion of the study?

Answer
No, you would only assign code 49083, which has an outpatient prospective payment system (OPPS) rate of $385.52 for 2012. It would not be appropriate to code 76705 in addition.

This is not really a change in OPPS. Last year, the payment limit for 49080 was $383.16 (when codes 49080 and 76942 were assigned). Code 76942 was packaged, and no additional payment was made for it. So you didn’t receive any revenue for the ultrasound then either, only the paracentesis.



October 8, 2012

Question
Can you tell me if CPT 49423 includes the catheter (C1729) for outpatient hospital billing? How would I find this out? Is there a list of procedures that include supplies available?

Answer
A procedure-to-device edit requires that you list C1729 when you bill 49423 under the hospital outpatient prospective payment system. There will be no additional payment since C1729 is packaged, but you must show the C code. This is the same as the nuclear medicine edits where you have to add the HCPCS code for the radiopharmaceutical with any nuclear medicine code but you don’t get paid for the diagnostic radiopharmaceutical.

For the current procedure-to-device edits, go to http://www.cms.gov/HospitalOutpatientPPS/02_device_procedure.asp#TopOfPage. To learn more about billing of devices by hospitals, see the following link to the Medicare Claims Processing Manual, Chapter 4, section 61: http://www.cms.gov/manuals/downloads/clm104c04.pdf.


 

October 1, 2012

Question
What code/s would be assigned for sacroiliac joint (SI) radiofrequency (RF) denervation?

Answer
CPT Assistant, December 2009 said to use code 64999 for this procedure.



September 24, 2012

Question
If a patient has magnetic resonance imaging (MRI) of the foot and ankle, would 73718 and 73721 be assigned or would it be 73721 x2 with modifier 59?

Answer
The Spring 2007 Clinical Examples in Radiology included the following answer to this question:

If an MRI of the ankle was ordered and the field of view extended to include part of the foot, code only for the ankle (MRI joint – 73721). However, if a new set-up and new coil are used with new parameters for the foot, then it would be appropriate to report two separate exams, 73721 for the ankle and 73718 for the foot.

 



September 17, 2012

Question
Would you agree that when doing an AP view of the abdomen with an oblique view that code 74010-52 would be assigned, or would you code 74000 to the lowest specificity?

Answer
I agree with your coding choice 74010-52 for AP and oblique abdominal x-rays. Clinical Examples in Radiology, Summer 2011, includes a Q & A concerning this.



September 10, 2012

Question
What is the difference between a thoracentesis with insert of tube (32422) and tube thoracostomy (32551)?

Answer
Code 32422 is used for a more transient procedure where the catheter/tube is removed at the end of the session, while 32551 is used for placement of a tube that is left in for a longer term. The following chart may help with accurate assignment of the pleural drainage codes.

32421 Needle in / needle out (+ modality specific guidance code)
32422 Catheter in / catheter out (+ modality specific guidance code)
32551 Catheter in / catheter stays in (+ 75989)
32550 Catheter tunneled / catheter stays in (+ 75989)

 


 

September 3, 2012

Question
How do we code for a CT-guided gastrostomy tube placement?

Answer
Code 49440 specifies fluoro guidance. If CT guidance is used instead of fluoro, assign code 49999 (Unlisted procedure, abdomen, peritoneum and omentum). (You might code 77012 in addition to 49999, but your payer may bundle that code into the payment.)



August 27, 2012

Question
If a patient has had a breast malignancy, should all subsequent mammography exams be ordered as diagnostic for the remainder of the patient’s life, or is there a point when the exam can return to a screening exam (if so when)?

Answer
That decision is up to the patient and her treating physician. A woman with a past history of breast cancer can have either screening or diagnostic depending on her particular clinical needs. There is no time frame. The decision for screening or diagnostic should come from the referring physician based on his/her knowledge of the patient. The American College of Radiology believes that all subsequent mammograms should be diagnostic, but the Centers for Medicare & Medicaid Services does not agree. For more on this, CLICK HERE.



August 20, 2012

Question
Does Medicare reimburse for sacroiliac (SI) joint steroid injections (27096)?

Answer
Code 27096 is a valid, active code for Medicare. However, if you are billing for the hospital, you must use G0260 instead of 27096 for anesthetic or steroid injections. Whether or not it will be paid depends on medical necessity, so check your local coverage determination (LCD). Code 27096 now requires and includes either fluoroscopic or computed tomography (CT) guidance. Do not code 77003 in addition to 27096. If guidance is not used, code 20552 instead of 27096.



August 13, 2012

Question
What are the correct CPT codes to use for Botox injections of the salivary glands?

Answer
The appropriate code is 64611 (chemodenervation of parotid and submandibular salivary glands, bilateral).  CPT Changes 2011, published by the American Medical Association has a clinical example for this code.  Also assign codes for guidance (76942, 77002, 77012, 77021).



August 6, 2012

Question
Can we code a PICC line removal with code 36589?

Answer
Codes 36589 and 36590 are assigned to report removal of a tunneled central venous catheter. PICC lines are generally not tunneled. The use of 36589 requires blunt dissection and additional work more than just pulling out the PICC. There is a parenthetical note under 36590 in the CPT book that indicates 36589 and 36590 may not be coded for removal of non-tunneled catheters.



July 30, 2012

Question
What CPT code would be appropriate to use for a MR venogram?

Answer
You would code the appropriate magnetic resonance angiography (MRA) of the body area. MRA (such as 70544) is magnetic resonance angiography, not MR arteriography. As such, the MRA includes imaging of arteries and/or veins.

From a clinical standpoint, your doctors and technologists may say that MRA and MRV of the brain are two different exams, but for coding purposes, they are considered one exam.



July 23, 2012

Question
If a patient is sent for an x-ray with a diagnosis of "injury," is it okay to assign diagnosis code 959.x?

Answer
Yes, an injury would be coded with the site-specific 959.x code. “Trauma,” however, is not considered necessarily as an injury and would be coded V71.4 in the absence of additional indications or findings. See AHA Coding Clinic for ICD-9-CM, 1Q 2006.



July 16, 2012

Question
We've been assigning unlisted code 76497 for a CT cystogram. Is that correct?

Answer
No, a computed tomography (CT) cystogram is a protocol that can vary from practice to practice but is, usually, a CT pelvis and possibly also a CT abdomen. Your doctor should dictate exactly what was performed, and your code choice would then be clear. See the Q & A in the January/February 2007 ACR Radiology Coding Source for more information.



July 9, 2012

Question
If the doctor does an ultrasound prior to paracentesis, can we code the ultrasound?

Answer
If the ultrasound is diagnostic, and, based on the findings, paracentesis is performed, you can code 76705. However, in most cases, the patient has known ascites with an order for paracentesis, and the ultrasound is done just for localization. That is part of the guidance that is now included in paracentesis code 49083.



July 2, 2012

Question
We do a swallowing function test with speech therapy. They code 92611 and we code 70371 and that's getting denied. What should we use?

Answer
Instead of 70371, you should be coding 74230. If you look at 92611, it says the radiology code is 74230. Code 70371 describes speech evaluation while 92611 and 74230 are swallowing function.



June 25, 2012

Question
Can you code 76770 for renal ultrasound, or would 76775 be the right code?

Answer
There are two ways that you can code 76770. Per the CPT book, 76770 consists of real-time scans of the kidneys, abdominal aorta, common iliac artery origins, and inferior vena cava, including any demonstrated retroperitoneal abnormality. Alternatively, if clinical history suggests urinary tract pathology, complete evaluation of the kidneys and urinary bladder also comprises a complete retroperitoneal ultrasound. If only the kidneys are imaged and documented, that would always be 76775.



June 18, 2012

Question
We did a right upper and right lower venous duplex, can we code 93971 x 2?

Answer
Yes, that is the correct way to code. Add modifier 59 to the second one, and be prepared to appeal. AMA/ACR published a Q & A on this in Clinical Examples in Radiology, Winter 2008.



June 11, 2012

Question
If we have performed 71010 and 71100, is there a single code that would replace this?

Answer
Yes, code 71101 is assigned if unilateral rib views and a PA chest are taken at the same session. If you add a PA chest to bilateral ribs, code 71111.




 




Click here
to return to the Compliance Question of the Week menu.

Copyright ©2012, 2011 by Medical Learning, Incorporated. All rights reserved.

Disclaimer: Bracco Diagnostics Inc. is pleased to provide customers with reimbursement support for products manufactured by the company and for medical procedures related those products based on Medicare reimbursement policies. Because private payer coverage policies and benefit plans greatly differ, the information offered in this guide may not be applicable for billing and reporting to private payers. The treating provider is responsible for determining the medical necessity for each specific patient case. Claims submitted to payers should reflect the medical decisions made by the treating provider, current applicable state and federal regulations, and the provisions of patient benefit plan. Bracco Diagnostics Inc. adheres to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) provisions and other applicable state and federal laws concerning the disclosure of protected health information (PHI). Our Reimbursement Services department does not enter into Business Associate Agreements (BAA) with customers. Therefore your institution should not disclose PHI to Bracco reimbursement representatives during the course of receiving reimbursement support. Current Procedural Terminology (CPT) codes and descriptions are copyright © 2007 American Medical Association (AMA). All Rights Reserved. CPT is a trademark of the AMA.

All users agree that they access and use this site at their own risk. Bracco has not reviewed all of the sites that may be linked to this site and makes no warranties or representations as to the accuracy, completeness and/or any other aspect of the information contained in any off-site pages or any other site linked to this site. All users agree that the linking is at their own risk.