Radiology Coding Alert

If your practice reports J2001 (Injection, lidocaine HCl for intravenous infusion, 10 mg) for lidocaine when you perform spinal injections, hyperthermia or thrombin injections, expect a flood of denials starting July 1. Although most payers already bundled lidocaine payment into your injection fees, a new NCCI edit confirms that you should never bill J2001 unless you treat a patient for cardiac arrhythmia.

History: HCPCS Codes deleted J2000 (Injection, lidocaine Hcl, 50 cc) this year and introduced J2001 in its place. Although most radiology coders accurately took this as a sign that Medicare never intended coders to use these codes for local anesthesia or nerve blocks for pain management, some coders simply changed their claim forms and started billing J2001 with every lidocaine injection.

NCCI's version 8.1 bundled J2000 into several injection codes, which seemed to stop many radiology practices from billing lidocaine with 36002 (Injection procedures [e.g., thrombin] for percutaneous treatment of extremity pseudoaneurysm), 36470-36471 (Injection of sclerosing solution ...), nerve block injections (64400- 64530) and other procedures. At the time, Georgia Medicare's lidocaine policy stated, "The dosage indicated by the code [J2000] description is specific to the treatment of cardiac arrhythmias and emergencies only. The billing of J2000 is not appropriate for the 1-2 cc usually required for a local anesthetic."

But when HCPCS introduced J2001, the new code breathed new life into the lidocaine debate for many practices. NCCI 10.2 shuts the door on any ambiguity, bundling J2001 into hundreds of codes.

"The injection of a 'caine'while doing a joint injection is for pain control and shouldn't be billed separately," says Denise Paige, CPC, president of the American Academy of Professional Coders'Long Beach Chapter. "There are those who think that this never should have been billed separately in the first place, and after J2000 was deleted, I think that further backs up that theory."

NCCI includes several new diagnostic radiology edits, but probably none that will dramatically affect your practice's bottom line. For instance, NCCI now bundles the brain magnetic resonance imaging codes 70551-70553 into the new codes 70558 (Magnetic resonance [e.g., proton] imaging, brain [including brain stem and skull base], during open intracranial procedure [e.g., to assess for residual tumor or residual vascular malformation]; with contrast material[s]) and 70559 (... without contrast material[s], followed by contrast material[s] and further sequences).

And, a mutually exclusive edit bars you from reporting the bone density scan codes 76076 (Dual energy x-ray absorptiometry [DEXA], bone density study, one or more sites; appendicular skeleton [peripheral] [e.g., radius, wrist, heel]) and 76977 (Ultrasound bone density measurement and interpretation, peripheral site[s], any method) with 76071 (Computed tomography, bone mineral density study, one or more sites; appendicular skeleton [peripheral] [e.g., radius, wrist, heel]).

In another mutually exclusive edit, NCCI now bars you from reporting the transvenous intrahepatic portosystemic shunt (TIPS) insertion code 37182 with the TIPS revision code 37183.

Also affecting interventionalists, NCCI bundles 43752 (Naso- or oro-gastric tube placement, requiring physician's skill and fluoroscopic guidance [includes fluoroscopy, image documentation and report]) into the codes for gastrostomy tube introduction and placement RS&I (74340-74350) and the code for small-intestine x-ray (74251). Although some professional radiology organizations don't believe that these edits are correct and may officially protest them, you should expect denials when you report these codes together. No modifiers can separate these code combinations.

NCCI also hits nuclear medicine, bundling the radiopharmaceutical tumor localization codes 78800-78802 into 79403 (Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion). The new edits also bundle the imaging codes 78185 (spleen), 78195 (lymphatics and lymph nodes), 78201 (liver) and 78215 (liver and spleen) into both 78804 (Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent[s]; whole body, requiring two or more days imaging) and 79403. You can use a modifier to separate these edits if the physician performs the services during separate sessions and your documentation proves that they were both medically necessary.

Note: Visit www.cms.hhs.gov/physicians/cciedits/default.asp for links to documents that explain the edits, including the NCCI Policy Manual for Part B Medicare Carriers, the Medicare Carriers Manual, and an NCCI Question-and-Answer page.