Radiology Coding Alert

At first glance, radiology coders may feel over-whelmed by the sheer volume of edits implemented in version 6.3 of the national Correct Coding Initiative (CCI). More than 57,000 edits were announced, effective Oct. 30, at least 27,000 of which pertain to radiology.

The vast majority of these edits apply to a single coding scenario albeit one that few radiology coders will ever encounter. Specifically, the new edit states that evaluation and management (E/M) services performed at the same time as procedures are considered bundled into those procedures unless they are significant and separately identifiable, and are appended with modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day as another procedure or service).

Most diagnostic radiologists provide only radiology interpretation services, not E/M services, according to Jean Stoner, CPC, manager of coding operations at CodeRyte, an internet-enabled coding service and software provider based in Bethesda, Md. Therefore, the policy shift reflected in the new CCI Edits will have little impact on radiology coding.

How Will CCI Affect Radiology Coding?

The fourth-quarter 2000 CCI edits, nonetheless, outline a comprehensive list of radiology codes into which E/M services would be bundled if they were ever performed by the radiologist. The Health Care Financing Administration (HCFA) proposed the new policy to prevent the practice of physicians reporting an E/M service code for the inherent evaluative component of the procedure itself. According to HCFA, The basis for this policy is that, because every procedure has an inherent E/M component, for an E/M service to be paid separately, a significant, separately identifiable service would need to be documented in the medical record.

E/M codes are occasionally reported in conjunction with select interventional, neurological and pain management codes, where radiologists may perform consultations followed by treatment. Most of these carry global surgical periods of zero, 10 or 90 days, which already require the use of modifiers -25 or -57 (decision for surgery) if E/M services are performed the same day as the procedure, according to Cheryl Schad, BA, CPCM, CPC, owner of Schad Medical Management, a billing and coding consulting firm located in New Jersey. The new CCI edits apply to procedures that have no global period.

The new edits may come into play, for instance, if an interventional radiologist is asked for a consultation to determine if a patient is a candidate for vertebroplasty. During the visit, the radiologist might order computerized axial tomography (CAT) of the lumbar spine (72131, 73132 or 72133). If the study is conducted and interpreted on the same day as the consultation, the radiologist may bill for both the CT and the E/M service, appended with the -25 modifier, if all the parameters in CPT for consult are met and documented.