Anesthesia Coding Alert

Mid-Year HCPCS Changes:

Get Up to Speed With New Q Code Requirements

Published on Tue May 17, 2005

Pair these 13 new codes with LOCM contrast agent billing

Have you entered new Q codes into your system lately? If not, check out the latest HCPCS Codes additions - 13 new Q codes that must be reported in conjunction with contrast agents - or prepare to deal with denials.

Add Contrast Codes to Your System

The new codes went into effect April 1, with one exception: Hospital outpatient departments should continue reporting the current A codes (A4644, A4645 and A4646, Supply of low osmolar contrast material ...) instead. You didn't have much time to implement the change (information was released March 11), so be sure your coding is up to speed.

Contrast agents covered by the new codes include:

Various dosages of low osmolar contrast material (LOCM) (codes Q9945, Q9946, Q9947, Q9948, Q9949, Q9950 and Q9951)

Magnetic resonance contrast agents (Q9952, Injection, gadolinium-based magnetic resonance contrast agent, per ml; Q9953, Injection, iron-based magnetic resonance contrast agent, per ml; and Q9954, Oral magnetic resonance contrast agent, per 100 ml)

Microspheres injection agents (Q9955, Injection, perflexane lipid microspheres, per ml; Q9956, Injection, octafluoropropane microspheres, per ml; and Q9957, Injection, perflutren lipid microspheres, per ml).

"Pain management has the potential to use the low osmolar contrast codes (Q9945-Q9951) in intrathecal injections," says Marvel J. Hammer, RN, CPC, CCS-P, CHCO, owner of MJH Consulting in Denver. Procedures you might use these new Q codes with include subarachnoid injection codes:

CPT 62310 - Injection, single (not via indwelling catheter), not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic

CPT 62311 - ... lumbar, sacral (caudal)

CPT 62318 - Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic

62319 - ... lumbar, sacral (caudal).

Important: You can also use the new Q codes any time the pain physician performs a procedure under fluoroscopy, or when he performs an arthrogram, epidurogram or diskogram, says Trish Bukauskas-Vollmer, CPC, owner of TB Consulting in Myrtle Beach, S.C. Just be sure he uses a minimum of 1 ml of contrast and that the physician is purchasing the supplies before you report it for reimbursement.

Take Advantage of These Benefits

Implementing new codes mid-year can be stressful, but Hammer says the new Q codes have advantages over the previously reported A codes in at least two areas:

Contrast volume: The old codes gave a range of iodine (such as 100-199 mg of iodine). The new Q codes clarify the volume injected (such as 3 ml), which gives coders better information to report the injection.

Unit worth: Because these codes rely on carrier-based reimbursement, the previous A codes had tremendous variance between the amount paid for "1 unit" - from a few cents to multiple dollars, Hammer says. The new code descriptors are very specific to eliminate any confusion over what one reported unit equals.

Take note: These details in the new codes mean that providers need even more thorough documentation than before. Providers must specify the quantity and strength of the agent injected rather than write vague notes such as "small amount of contrast" or "contrast injected."

Put Other Carriers on Hold

Remember, these new Q codes only apply to Medicare claims right now (Q codes are often considered to be temporary Medicare HCPCS codes). Other payers might accept them in 2006 if Medicare does not revise current A codes or create new A codes to match the descriptors.

Pricing for the new codes is based on the Average Sales Price (ASP) plus 6 percent, effective April 1. See the chart below for payment information. For complete descriptors, log on to http://www.cms.hhs.gov/providers/drugs/default.asp.

For a quick reference chart detailing payment limits for the new Q codes, contact editor Leigh DeLozier at http://leighdelozier@bellsouth.net..