Radiology Coding Alert

Pull out the red pen to correct a dangerous error in your manual.

In 2011, 47490 joined the ranks of "complete" interventional codes -- meaning the encounter requires just one code to represent the procedure and related radiology services. Read on for important information on why CPT created this code and how you're expected to use it.

See What Revised 47490 Includes to Earn $365

CPT 2011 revised 47490 so that it now represents the "complete" service required for percutaneous creation of an opening in the gallbladder:

• 2010: 47490 -- Percutaneous cholecystostomy
• 2011: 47490 -- Cholecystostomy, percutaneous, complete procedure, including imaging guidance, catheter placement, cholecystogram when performed, and radiological supervision and interpretation.

Percutaneous cholecystostomy is a life-saving procedure used to buy time for patients who are too ill to undergo gallbladderremoval, noted the presentation by Geraldine McGinty, MD, MBA, representing the American College of Radiology at the AMA's CPT and RBRVS 2011 Annual Symposium. Medicare's national rate for 47490 runs around $365, and CMS assigned the code a 10-day global period. That means related E/M services on the day of the procedure (following decision for surgery) and for the 10 days following the procedure aren't payable separately. In fact, two post-procedure visits are factored into the fee, McGinty's presentation stated.

Strike Out RS&I Note to Prevent Denials

Key point: "CPT is continuing their previous pattern of bundling the ancillary services that are typically part of procedures, including radiological guidance," says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of

Washington Physicians Compliance Program in Seattle. As part of the change to a "complete" code, CPT 2011 adds a note with 47490 telling you not to report the code with 47505 (Injection procedure for cholangiography ...) or with radiology codes 74305, 75989, 76942, 77002, 77012, or 77021.

Caution: You may find that your CPT manual contradicts itself in the notes under 47490. As mentioned above, the manual states you should not report 47490 with 75989 (Radiological guidance [i.e., fluoroscopy, ultrasound, or computed tomography], for percutaneous drainage [e.g., abscess, specimen collection], with placement of catheter, radiological supervision and interpretation). But immediately under that, many manuals have the line, "For radiological supervision and interpretation, use 75989."

That last sentence was printed erroneously in CPT 2011, according to AMA's published errata. To correct this inaccuracy, delete the information directing you to report 75989 for radiological supervision. (Note: Learn more about the published errata in next month's issue).