Radiology Coding Alert

70370, 70371 edit teaches the importance of checking additions and deletions.

Correct Coding Initiative (CCI) version 17.2, which took effect July 1, offers 2,367 new edit pairs and deletes 336 bundles, according to an analysis by Frank Cohen, MPA, MBB, principal and senior analyst with The Frank Cohen Group, LLC.

We've sorted through the new and deleted pairs, discovering changes affecting speech and swallowing studies, MRI and MRA scans, and spinal studies.

70370, 70371 Edit Change Has a Twist

You may not use 70370 (Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique) much these days, but it presents an interesting lesson on CCI edits: You can't assume that an edit deletion means you may report the two codes involved together. Sometimes, when CCI deletes an edit, it creates a new edit for the same codes but swaps the column each code falls in.

Case in point: Before CCI 17.2, you faced a mutually exclusive edit with 70370 in column 1 and 70371 (Complex dynamic pharyngeal and speech evaluation by cine or video recording) in column 2. The edit had a modifier indicator of 1, meaning you could report both on the same claim (with an appropriate modifier to override the claim) if the services were truly distinct. CCI 17.2 deletes that edit.

What you don't want to miss is that CCI 17.2 also adds a new mutually exclusive edit, effective July 1, swapping the columns the codes are in so that 70370 is bundled into  70371. The modifier indicator is now "0," so you may never override the edit. That means you should never report these two codes for the same date of service when performed by the same provider.

Watch Modifier Indicators With 92611 Edits

CCI 17.2 also creates edits bundling 70370 and 70371 into 92611 (Motion fluoroscopic evaluation of swallowing function by cine or video recording). You may override the 92611/70370 edit with a modifier when warranted, but you may never override the 92611/70371 edit.

Remember: CCI edits apply only to services performed by the same provider. For example, if the radiologist performs a 70371 service and another provider, such as a speech language pathologist, performs a 92611 service on the same date for the same patient, the edit will not prevent you from reporting 70371.

To be sure you're using the codes properly, take a moment to review what the codes represent.

70371 vs. 92611: CPT® Assistant (Dec. 2004) explains that 92611, which represents a swallowing study, differs from 70371, "which is a videofluoroscopic study of the pharynx and speech evaluation that assesses movement and function of the soft palate as it closes during speech."

70371 vs. 74230: Coders often confuse speech evaluation code 70371 with swallowing evaluation code 74230 (Swallowing function, with cineradiography/ videoradiography). Code 74230 is the one you'll typically report to indicate imaging for a 92611 swallowing study.

MRA Lands Column 1 Spot in MRI Edits

CCI 17.2 ensures you aren't reporting MRI codes with MRA codes for the same anatomic site.

Spine: CCI 17.2 bundles 72141-72158 (Magnetic resonance [e.g.], proton) imaging, spinal canal and contents, cervical; without contrast material) into 72159 (Magnetic resonance angiography, spinal canal and contents, with or without contrast material[s]).

Upper extremity/joint: The latest version also bundles 73218-73220 (Magnetic resonance [e.g., proton] imaging, upper extremity, other than joint ...) and 73221-73223 (Magnetic resonance [e.g., proton] imaging, any joint of upper extremity ...) into MRA code 73225 (Magnetic resonance angiography, upper extremity, with or without contrast material[s]).

These MRA/MRI edits have a modifier indicator of 1, so you may override them with a modifier on the MRI code when the services are distinct.

CCI also creates edits bundling 3D rendering codes 76376-76377 into the MRA codes 72159 and 73225. A modifier indicator of 0 means you may never override the edit.

Watch out: In rare cases, a patient may require a medically necessary MRI with 3D reconstruction at one session and an MRA at another session on the same date. For example, suppose in the morning the patient required a medically necessary MRI (73218) with 3D (76376 or 76377) and later in the day the patient required a medically necessary MRA (73225). This would lead you to report a 3D reconstruction code (performed for the MRI) on the same claim as MRA code 73225.

In this situation, you can expect the edit that prevents you from reporting 3D reconstruction and the MRA code on the same claim to trigger a denial, says Helen Avery, CPC-I, CHC, compliance resource consultant for MediRegs.

Although you may succeed in appealing the denial, your practice should weigh the payment for the 3D reconstruction against the time and energy an appeal requires. This rare situation yields a "relatively low revenue impact," Avery notes. If you perform both the professional and technical components, you can expect roughly $72 for 76376 and $93 for 76377, based on national payment rates. The professional component of 76376 earns about $10 and 76377 brings close to $40.

Leave 76800 Off of CSF Imaging Claim

If you're considering reporting a spine ultrasound with a cerebrospinal fluid (CSF) imaging code, not so fast. CCI 17.2 bundles 76800 (Ultrasound, spinal canal and contents) into the following codes:

• 78630, Cerebrospinal fluid flow, imaging (not including introduction of material); cisternography
• 78635, ... ventriculography
• 78645, ... shunt evaluation
• 78647, ...tomographic [SPECT]
• 78650, Cerebrospinal fluid leakage detection and localization.

The modifier indicator of 1 means you may override these edits by appending a modifier to 76800 when the services are distinct.

Resource: The modifier typically associated with overriding CCI edits is modifier 59. Because so many claims improperly use modifier 59, it's under constant watch by auditors. Help keep your claims compliant by reading CMS's "Modifier 59 Article: Proper Usage Regarding Distinct Procedural Service" at www.cms.gov/NationalCorrectCodInitEd/ (the link is in the Downloads section).