Radiology Coding Alert

Version 9.0 of the Correct Coding Initiative (CCI ), which took effect on Jan. 1, bundles 72275 (Epidur-ography, radiological supervision and interpretation) into several neurological injection codes, including 62281* (Injection/infusion of neurolytic substance [e.g., alcohol, phenol, iced saline solutions], with or without other therapeutic substance; epidural, cervical or thoracic) and the injection codes 64470, 64475, 64479 and 64483.

"These edits were most likely added to prevent billing the diagnostic radiological supervision and interpretation service when radiologists injected a small amount of contrast material to verify needle or catheter position," says Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc., a reimbursement consulting firm in Dallas, Ga.

Aortography Bundled into 34825

The new CCI edition also bundles 75625 (Aortography, abdominal, by serialography, radiological supervision and interpretation) and 75630 (Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation) into 34825 (Placement of proximal or distal extension prosthesis for endovascular repair of infrarenal abdominal aortic or iliac aneurysm ...; initial vessel), which represents a significant change for 2003, Parman says, because many practices previously reported the diagnostic aortic imaging and/or runoff separately.

Fluoroscopy code 76000 is bundled into 51005* (Aspiration of bladder; by trocar or intracatheter) and 51010 (... with insertion of suprapubic catheter), but this edit simply confirms CPT's direction to report 76003 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) for imaging guidance during catheter placement.

NCCI Edits now bundles 20551 (Injection[s]; tendon origin/insertion), 20552 ( single or multiple trigger point[s], one or two muscle[s]) and 20553 (... single or multiple trigger point[s], three or more muscles) into radiological service codes 72240 (Myelography, cervical, radiological supervision and interpretation), 72265 ( lumbosacral) and 72295 (Diskography, lumbar, radiological supervision and interpretation). "I'm not certain that the same physician specialty would perform both the diagnostic imaging study and the trigger point injection, so I don't think these edits will affect too many practices," Parman says. "In addition, the CCI bundles 76003 into the trigger point injection codes 20552 and 20553, probably because imaging guidance is not necessary for these injections."

Radiation Oncology G Codes Bundled

Noteworthy to radiation oncology practices, the CCI bundles SRT and IMRT treatment and planning codes for services performed on the same day. SRT planning and treatment codes G0242 (Multi-source photon stereotactic radiosurgery [cobalt 60 multi-source converging beams] plan, including dose volume histograms for target and critical structure tolerances, plan optimization performed for highly conformal distributions, plan positional accuracy and dose verification, all lesions treated, per course of treatment) and G0243 (Multi-source photon stereotactic radiosurgery, delivery including collimator changes and custom plugging, complete course of treatment, all lesions) may not be reported on the same day as the IMRT treatment code 77418 (Intensity modulated treatment delivery, single or multiple fields/arcs, via narrow spatially and temporally modulated beams [e.g., binary, dynamic MLC], per treatment session).

"SRT and IMRT are never reported for the same volume on the same day anyway, so this shouldn't affect the way practices report these services," says Deborah I. Churchill, RTT, president and founder of Churchill Consulting Inc., a Killingworth, Conn., consulting firm that offers audits, seminars and electronic coding applications. Churchill reminds practices that the edits only apply to services performed on the same day, "but you can still report these procedures on different days within the same course of treatment."