Radiology Coding Alert

The latest round clears up brain MRI coding, but not same-vessel intervention controversy Correct Coding Initiative (CCI) version 14.1 focuses many of its more than 2,000 edits on radiology codes. You could spend hours weeding through the latest round of edits, but we've already done the deciphering for you in these seven tips. Take a look at the diagnostic and interventional radiology edits you need to incorporate into your coding, effective April 1. 1. Stick to Designated 32998 Guidance Codes CCI 14.1 includes edits for guidance codes that you shouldn't use for radiofrequency ablation (RFA), says radiology coding expert Jackie Miller, RHIA, CPC, senior coding consultant for Coding Strategies Inc. in Powder Springs, Ga. The next time you report guidance for lung ablation (32998, Ablation therapy for reduction or eradication of one or more pulmonary tumor[s] including pleura or chest wall when involved by tumor extension, percutaneous, radiofrequency, unilateral), double-check the codes CPT guidelines instruct you to use: • 76940 -- Ultrasound guidance for, and monitoring of, parenchymal tissue ablation • 77013 -- Computed tomography guidance for, and monitoring of, parenchymal tissue ablation • 77022 -- Magnetic resonance guidance for, and monitoring of, parenchymal tissue ablation. Some coders have been misusing 76998 (Ultrasonic guidance, intraoperative) and 77021 (Magnetic resonance guidance for needle placement [e.g., for biopsy, needle aspiration, injection or placement of localization device] radiological supervision and interpretation) with 32998, according to CCI 14.1. Result: CCI established the following nonmutually exclusive edits to clean up your RFA guidance coding: Remember: Payers will cover only the column 1 code if you report a nonmutually exclusive edit pair together. The modifier indicator "1" means that you may override the edit with an appropriate modifier if you meet certain conditions, such as the services taking place at different sessions or anatomical sites. 2. Choose Vertebroplasty-Specific 72292 To put a stop to misusing CT guidance codes 76380 (Computed tomography, limited or localized follow-up study) and 77011 (Computed tomography guidance for stereotactic localization) with 72292 (Radiological supervision and interpretation, percutaneous vertebroplasty or vertebral augmentation including cavity creation, per vertebral body; under CT guidance), CCI now bundles both 76380 and 77011 into 72292. This edit has a "1" modifier. What to do: You should report CT guidance for vertebroplasty procedures with only 72292, Miller says. 3. Think Before Reporting Brain MRIs Together CCI aimed to halt misusing intracranial MRI codes 70557-70559 with functional brain MRI codes 70554-70555, Miller says. The edits have a "1" modifier indicator. But you're unlikely to perform these services together, she says. 4. CCI Is Still Adding GJ-Tube Edits CPT 2008 added 49446 (Conversion of gastrostomy tube to gastro-jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection[s], image documentation and report). And [...]