Radiology Coding Alert

Edit deletion could bring your practice up to $120 more than before

Radiology coders can finally cheer some good news from the National Correct Coding Initiative (NCCI): The latest version (10.1) doesn't contain any critical new bundles affecting radiologists, and it actually deletes several bothersome bundles.
 
The old way: NCCI Edits version 9.3, which took effect last October, bundled CPT 76830 (Ultrasound, transvaginal) into 76856 (Ultrasound, pelvic [nonobstetric], B-scan and/or real time with image documentation; complete) and 76857 (... limited or follow-up [e.g., for follicles]).

Reality: This meant that you could not report these codes together if you performed both services on the same day, unless you appended modifier -59 (Distinct procedural service) to 76830.

The new way: The latest edits, which are in effect as of April 1, allow you to report 76830 (which can pay up to $120) with 76856 and 76857. Because NCCI no longer includes this edit, you do not need to append modifier -59 when you perform these procedures together.

"Of course, this does not negate medical-necessity requirements," says Heather Corcoran, manager of CGH Billing Services, a medical billing firm in Louisville, Ky. "You can't just perform pelvic and transvaginal ultrasounds in combination for every patient as a rule. You have to be able to prove why both were necessary if your insurer asks."

CV Access Guidance Edits Deleted

In addition, as we anticipated in the April issue of Radiology Coding Alert, the NCCI also deleted the edit that classified +75998 (Fluoroscopic guidance for central venous access device placement, replacement [catheter only or complete], or removal [includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic supervision and interpretation, and radiographic documentation of final catheter position] [list separately in addition to code for primary procedure]) and +76937 (Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting [list separately in addition to code for primary procedure]) as mutually exclusive codes.

Visit www.cms.hhs.gov/physicians/cciedits/default.asp for links to documents that explain the edits, including the NCCI Policy Manual for Part B Medicare Carriers, the Medicare Carriers Manual, and an NCCI Question-and-Answer page.