Radiology Coding Alert

Learn which of the edit pairs you may never report together.

Correct Coding Initiative (CCI) version 16.3 went into effect Oct. 1, 2010. Among its more than 19,000 additions are a number of interventional and PET bundles you should know.

1. Watch Out for 0228T, 0230T Bundles Galore

If you perform transforaminal epidural injections with ultrasound guidance, do yourself a favor and check CCI edits before you submit your claim.

Here's why: Most of the new edit additions revolve around the newly-introduced Category III CPT codes that went into effect on July 1:

• 0228T -- Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic; single level
• 0230T -- Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral; single level.

In his analysis of the edits, Frank Cohen, principal and senior analyst for the Frank Cohen Group, noted that for column two codes, 0228T and 0230T accounted for more than half of all unique pairs. That adds up to more than 10,000 bundles involving these two codes, spanning throughout every section of CPT, from anesthesia to the physical therapy codes.

In addition, you'll find nearly 40 new edits each for related codes 0229T (Injection[s], anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic; each additional level [List separately in addition to code for primary procedure]) and 0231T (Injection[s], anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral; each additional level [List separately in addition to code for primary procedure]).

2. PICC + Chest X-Ray = Denial

The latest edits also bundle chest X-ray codes 71010 (Radiologic examination, chest; single view, frontal) and 71020 (Radiologic examination, chest, 2 views, frontal and lateral) into several PICC and central venous access device codes:

• 36560-36566, 36569-36571 (insertion)
• 36575-36576 (repair)
• 36578-36585 (replacement)
• 36595-36596 (mechanical removal of obstructive material).

Fortunately, these edits shouldn't disrupt your usual coding because physicians typically place lines under fluoroscopic guidance, says Michele Midkiff, CPC-I, PCS, RCC, executive director of Coding Affiliates Inc., an interventional coding service in Mountain View, Calif.

But you should be aware of the bundle in case you need to report a distinct chest X-ray performed on the same date. The edits have a modifier indicator of 1, which means you may override the edit with a modifier when appropriate.

3. Pick PET/Tracer Pair With Care

Another new group of edits prevent payment of A9526 (Nitrogen n-13 ammonia, diagnostic, per study dose, up to 40 millicuries) and A9555 (Rubidium rb-82, diagnostic, per study dose, up to 60 millicuries) with these PET codes:

• 78608 -- Brain imaging, positron emission tomography (PET); metabolic evaluation
• 78811-78813 -- Positron emission tomography (PET) imaging ...
• 78814-78816 -- Positron emission tomography (PET) with concurrently computed tomography (CT) for attenuation correction and anatomical localization imaging ....

These edits have a modifier indicator of 0 so you may never override the edit.

These bundles fall in line with CMS's previous instructions on pairing tracer codes and PET codes. According to MLN Matters article MM5665, when you submit claims for 78608 or 78811-78816, you should use only tracer code A9552 (Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries).

Tracer codes A9555 and A9526 are appropriate for claims containing 78491 or 78492 (Myocardial imaging ...), the article states (www.cms.gov/MLNMattersArticles/downloads/MM5665.pdf).