Radiology Coding Alert

Don't write off your radiology supply code reimbursement if your practice purchased the supplies

If your imaging center wants to collect speedy and appropriate medical supply reimbursement, you should report the appropriate HCPCS Code - as long as you purchased the supplies in the first place.

"I've talked to other coders who see denial after denial for supplies like gadolinium (A4647) when they bill it with MRIs, so they stop bothering with the supply codes," says Tina Coch, coder at Imaging Associates in Las Vegas. "But that's crazy. Medicare will pay for some supply codes. So if you don't bill the codes, you're just losing money. After all, you bought those supplies in the first place."

HCPCS'"Supplies for Radiologic Procedures" section contains several codes that your radiology practice probably uses every week, including the following partial listing of the supply codes:

A4641 -- Supply of radiopharmaceutical diagnostic imaging agent, not otherwise classified

A4643 -- Supply of additional high dose contrast material(s) during magnetic resonance imaging, e.g., gadoteridol injection

A4644 -- Supply of low osmolar contrast material (100-199 mgs of iodine)

A4645 -- Supply of low osmolar contrast material (200-299 mgs of iodine)

A4646 -- Supply of low osmolar contrast material (300-399 mgs of iodine)

A4647 -- Supply of paramagnetic contrast material (e.g., gadolinium)

A9500 -- Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m sestamibi, per dose

A9502 -- Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m tetrofosmin, per unit dose

A9503 -- Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m, medronate, up to 30 millicurie

You can report these supply codes, as long as your practice purchased them. Radiologists who practice in a hospital setting probably won't bill for these supplies because the hospital normally purchases the supplies. Freestanding centers, on the other hand, usually buy the materials directly and therefore may report them along with any relevant procedural or supervision and interpretation codes.

Carriers Limit Reimbursement

Of the supply codes, radiologists report the codes for low osmolar contrast material (LOCM) most frequently. Aglance at your HCPCS manual might confuse you when you select your LOCM codes because the guide indicates that HCPCS deleted A4644-A4646 and replaced them with A9525 (Supply of low or iso-osmolar contrast material, 10 mg of iodine). But just because the code deletion is in black and white doesn't mean it's still valid. Effective April 1, CMS reinstated A4644-A4646 and declared that A9525 was invalid.

Most payers only allow you to separately report LOCM supplies for patients with a history of allergy to contrast material, asthma or significant cardiac dysfunction. Check with your payer to determine whether it places any restrictions on your LOCM billing.