Question: I’m new to radiology coding and I’m having trouble choosing which HCPCS Level II codes to assign for the following contrast information in a procedure note:
“A mixture prepared using 0.1 cc Magnevist gadolinium contrast, 10 cc preservative free saline, and 10 cc Conray 60 iodinated contrast at a 1:200 dilution was administered without incident under real-time fluoroscopic observation. 15 cc total administered volume.”
Can you direct me to the correct codes?
New York Subscriber
Answer: That is quite the combination of contrast materials, and you’ll need two or possibly three HCPCS Level II codes for the materials used, depending on your place of service.
Assign 1 unit of A9579 (Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (NOS), per ml) for the 0.1 cc of Magnevist gadolinium contrast. Report 1 unit of A4216 (Sterile water, saline and/or dextrose, diluent/flush, 10 ml) for the saline, depending on the place of service. If you’re coding for an outpatient imaging center, you could bill for the saline, but a larger facility like a trauma center may not bill for the saline.
Then, you’ll assign 10 units of Q9961 (High osmolar contrast material, 250-299 mg/ml iodine concentration, per ml) for the 10 cc Conray 60 iodinated contrast. Conray 60 is a high-osmolar contrast material, but it hasn’t been used much in medical imaging in recent years. So, you might want to be ready for the possibility that the claim is flagged for review or denied.
Mike Shaughnessy, BA, CPC, Development Editor, AAPC
