Radiology Coding Alert

See why reporting these codes together was already noncompliant.

Correct Coding Initiative (CCI) edits have caught up with a couple of CPT® instructions for computed tomographic angiography (CTA).

The codes involved are:

• 73706, Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing
• 74175, Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and image postprocessing
• 75635, Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast material(s), including noncontrast images, if performed, and image postprocessing.

Effective April 1, 2012, for physicians, CCI will add the following edits preventing you from reporting 73706 with either 74175 or 75635, according to Frank Cohen, principal and senior analyst for The Frank Cohen Group, in his NCCI Change Analysis 18.1, available from www.frankcohengroup.com/Library/ResearchandStudies.aspx (you may need to register to view the document).

For both edits, 73706 is in the column 2 position. If you report both the column 1 code of the edit and the column 2 code, Medicare and other payers who apply CCI edits will deny the column 2 code. For instance, if you report 74175 and 73706 on the same claim, expect a denial for 73706.

74175/73706: Watch the Modifier Indicator

The 74175/73706 edit matches half of an instruction that follows 74175 in the 2012 CPT® manual.

According to the instruction, you should not report 74175 (CTA abdomen) with either 73706 (CTA lower extremity) or 75635 (CTA abdomen with runoff). CCI already has an edit in place preventing you from reporting 74175 with 75635.

The 74175/73706 edit has a modifier indicator of 1, meaning that you may override the edit with a CCI modifier when appropriate. A typical example is the use of modifier 59 (Distinct procedural service) on the column 2 code to indicate performance of the exams at different sessions.

75635/73706: Don't Double Dip for 'Lower Extremity'

The 75635/73706 bundle also reconciles CCI edits with CPT® instructions.

A note with 75635 tells you not to report 75635 in conjunction with several codes, including 73706.

The 75635/73706 edit has a 0 modifier indicator, so you may never override the edit. The reason is that 75635 is a more extensive procedure than 73706. In other words, the 75635 service (abdominal aorta CTA with lower extremity runoff) by definition includes the 73706 service (CTA lower extremity).

Remember 74174 for Abdomen + Pelvis

When you're coding these CTA services, don't forget to check whether the new-for-2012 abdominal and pelvic CTA code would be more appropriate: 74174 (Computed tomographic angiography, abdomen and pelvis, with contrast material[s], including noncontrast images, if performed, and image postprocessing).

You should not report 74174 with 73706, 74715, or 75635, according to CCI edits and an instruction with 74174.

Avoid denials by checking your claims against the edits and CPT® guidelines prior to submission. Currently effective edits are available for download from www.cms.gov/NationalCorrectCodInitEd/NCCIEP/list.asp.