Radiology Coding Alert

Radiology coders must pay close attention to new edits implemented by the Correct Coding Initiative (CCI) version 8.0 effective Jan. 1, 2002. The modifications bundle a number of component codes into comprehensive procedures, rendering it inappropriate to report each service independently for payment. According to Cindy Parman, CPC, CPC-H, co-owner of Coding Strategies Inc., an Atlanta-based firm that supports 1,000 radiologists and 350 physicians from other specialties, the most-affected codes are from the radiation oncology section of CPT, along with a number of procedures that now include fluoroscopy, 3-D reconstruction and computerized tomography (CT) services that were previously billed separately.
Edits Affect Radiation Oncology
"The changes made in radiation oncology are considered devastating to many in the field," Parman says. Radiation oncologists and freestanding treatment centers were delighted with the addition of two new codes describing intensity modulated radiation therapy (IMRT) planning and treatment in CPT Codes 2002:
  77301 Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications
  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.
The codes describe important new services and were assigned high relative value units (RVUs) 77301 carries 39.13 fully implemented nonfacility total RVUs, while 77418 carries 16.18.
 
But much of the delight has been undercut with the CCI Edits, which bundle in nearly every possible related service. "We had feared this would happen, and it is very disappointing," says Parman. "The edits bundle in isodose planning, CT studies, treatment delivery, special dosimetry, treatment devices, therapy management, special treatment procedures, everything. These edits have taken codes that paid well and turned the situation completely around."
 
Office visits have also been bundled into many radiation oncology codes, leaving consultations (99241-99245) as the only E/M service that may be billed separately. "Radiation oncologists and coders will need to be very careful to ensure they follow the rules about what constitutes a consultation before they submit those charges," says Stacey Hall, RHIT, CPC, CCS-P, director of corporate coding for Medical Management Professionals Inc., a national billing and management firm for hospital-based practices in Chattanooga, Tenn.

Fluoroscopy and 3-D Reconstruction Edits
While CPT 2002 included a plethora of cross-references explaining when fluoroscopy code 76003 (Fluoroscopic guidance for needle placement [e.g. biopsy, aspiration, injection, localization device]) is bundled into other services, Hall says, the new edits further clarify the inclusion of fluoroscopy within the radiology supervision and interpretation (RS&I) services as provided in most clinical procedures. For instance, 74320 (Cholangiography, percutaneous, transhepatic, radiological supervision and interpretation), 74350 (Percutaneous [...]