Radiology Coding Alert

This April Fools' Day brought some good news for radiology coders. Three Correct Coding Initiative (CCI) edits got the boot, allowing you to report fluoroscopic guidance in certain arthrogram cases. Here's what you need to know.

Version 16.1 of the CCI edit database is effective April 1, notes a March 22 announcement by Frank Cohen, MPA, MBB, senior analyst with MIT Solutions Inc.in Clearwater, Fla. In addition to the new edit pairs, there are 142 edit pairs reported as terminated (no longer effective) for this release, he adds.

Winning the role of "most likely to affect your radiology practice" is the deletion of edits bundling 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) into the following codes:

27093 -- Injection procedure for hip arthrography; without anesthesia

27095 -- ... with anesthesia

27370 -- Injection procedure for knee arthrography.

"This is an important change," says Kim French, CIRCC, director of interventional coding and reimbursement for Crouse Radiology Associates in Syracuse, N.Y."It's commonplace now for patients to present for a contrast joint injection under fluoroscopy and then have an MRI or CT (which is referred to as an arthrogram)," she says. This change "allows you to bill for those services appropriately," French says.

The American College of Radiology (ACR) and American Society of Neuroradiology (ASNR) argued for the change, claiming that "fluoroscopy is inclusive to the 70000 series arthrography codes, not the surgical codes," states the ACR's January/February 2010 Coding Source (www.acr.org/Hidden/Economics/FeaturedCategories/Pubs/coding_source/archives/JanFeb2010.aspx).

In other words, if you're coding for CT arthrography or MRI arthrography, the societies argue that reporting all of the following is appropriate:

• Injection procedure code (such as 27370)
• Fluoroscopic procedure (77002)
• Arthrography imaging code (such as 73701,Computed tomography, lower extremity; with contrast material[s]).

Rationale: The societies argue that you should be allowed to report 77002 separately in the above cases because fluoroscopic guidance for an enhanced CT or MR arthrograph intra-articular injection requires more physician work than an intravenous contrast injection for typical CT and MR "with contrast" procedures.

Payoff: Medicare's national rate (unadjusted for geography) for 77002 is $69.64 for the global service and $27.06 for the professional component.

Caution: The CCI edit change applies to MR arthrograms and CT arthrograms, meaning an MRI or CT with intra-articular contrast. If you're reporting a formal fluoroscopic arthrogram, which isn't as common, you should not include 77002 on the claim, says French.

For example, if the service merits 27370 and 73580 (Radiologic examination, knee, arthrography, radiological supervision and interpretation), you should not report 77002, as well.

Reason: Fluoroscopy use is included in the arthrogram radiological supervision and interpretation (RS&I) codes, French explains. And the CPT manual backs this explanation with notes such as, "Do not report 73580 in conjunction with 77002."