Radiology Coding Alert

Special radiation treatment includes intraoperative radiation; needle placement and injection gain identity.

Effective July 1, 2013, the Correct Coding Initiative (CCI) version 19.2 offers up some updates in bundles for fluoroscopy and radiation treatment. While some bundles are deleted, others have been added in. The good news is that you can now earn for needle placements and injections. Here is an update on the bundles you need to be aware of.

Banish Bundles for Injection and Needle Placement

CCI 19.2 deletes the edits bundling the needle placement fluoroscopy code 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) with tendon or ligament injection codes. Thus, 77002 is no longer bundled with 20550 (Injection[s]; single tendon sheath, or ligament, aponeurosis [e.g., plantar “fascia”]) or 20551 (Injection[s]; single tendon origin/insertion).

Rationale: Needle placement and subsequent injection into the tendon, tendon sheath, or ligament are independent procedures. You can now earn for both steps.

Do Not Report 77470 With 77469

You report code 77470 (Special treatment procedure [e.g., total body irradiation, hemibody radiation, per oral or endocavitary irradiation]) for special treatment radiation procedures. The special treatment code, 77470, is commonly reimbursed by payers, but can easily be misused. To avoid problems in reimbursement for code 77470, you can document that special treatment planning was used, says Carl Bogardus, MD, FACR, president of Cancer Care Network, a billing and coding consulting firm in Midwest City, OK.

Code 77470 is a column 2 code for 77469 (Intraoperative radiation treatment management). Code 77470 is bundled into code 77469 and cannot be billed with 77469.

Note: According to Medicare regulations, 77470 covers the additional physician effort and work required for the special procedures of hyperfractionation, total body irradiation, per oral or transvaginal cone use, brachytherapy, hyperthermia, combination with chemotherapy or other combined modality therapy, stereotactic radiosurgery, intraoperative radiation therapy, and any other special time-consuming plan.

Watch the Bundle in Fluoroscopy and Defibrillator Codes

There is a bundle in the fluoroscopy and ultrasound guidance codes and the codes for subcutaneous defibrillator electrodes.

The codes 76000 (Fluoroscopy [separate procedure], up to 1 hour physician or other qualified health care professional time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]), 76001 (Fluoroscopy, physician or other qualified health care professional time more than 1 hour, assisting a nonradiologic physician or other qualified health care professional [e.g., nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy]), 76942 (Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation), and 76998 (Ultrasonic guidance, intraoperative) are column 2 codes for the following:

• 0319T (Insertion or replacement of subcutaneous implantable defibrillator system with subcutaneous electrode)
• 0320T (Insertion of subcutaneous defibrillator electrode)
• 0321T (Insertion of subcutaneous implantable defibrillator pulse generator only with existing subcutaneous electrode)
• 0322T (Removal of subcutaneous implantable defibrillator pulse generator only)
• 0323T (Removal of subcutaneous implantable defibrillator pulse generator with replacement of subcutaneous implantable defibrillator pulse generator only)
• 0324T (Removal of subcutaneous defibrillator electrode)
• 0325T (Repositioning of subcutaneous implantable defibrillator electrode and/or pulse generator)

You may report these codes together but only with an appropriate modifier.