Radiology Coding Alert

Plus: You'll need to append modifier 59 for external iliac aneurysm repair

The most recent round of National Correct Coding Initiative edits may cramp your G code style. The bulk of the bundles translate to no extra payment for injections and infusions.

Don't miss: In addition to explaining G code changes, we'll update your understanding of duplex and AAA repair coding to keep your claims compliant.
 
Remember: NCCI Edits , version 11.2, went into effect on July 1 for physician and imaging center claims, so you should be applying these edits to all services provided on or after July 1 if your payer adopts NCCI edits. The complete list of physician and imaging center edits is on the CMS Web site at www.cms.hhs.gov/physicians/cciedits/.

Jump On the G Code Bundle Bandwagon

Don't report infusion and injection codes G0345, G0347, and G0351-G0354 with procedures totaling in the thousands, NCCI 11.2 says. The G codes are column 2 codes in nonmutually exclusive edits. Translation: If you report a G code along with the column 1 code it's paired with, your payer will only reimburse you for the column 1 procedure. You will be able to override these edits by using a modifier when your documentation supports reporting the two codes separately, because they have a modifier indicator of "1."

What this means for you: Think twice before reporting a G code alongside a brachytherapy or PET code. Clinical brachytherapy codes 77761-77784 all include the G codes now. The same holds true for a number of PET codes: 78491 and 78492 (myocardial imaging), 78608 and 78609 (brain imaging), and 78811-78816 (tumor imaging) also include these G codes.

Reason: Injection is considered an inherent part of most procedures, says Dawn Hopkins, senior manager for reimbursement with the Society for Interventional Radiology (SIR). Either CMS is seeing "widespread abuse" of the new injection G codes by physicians trying to bill for them with many procedures, or this is a precaution. CMS may simply be trying to block all of the code combinations that haven't been commonly used so far, because they assume nobody ever bills them together, she says.

Include Venipuncture With PET

New PET edits also involve 36000 (Introduction of needle or intracatheter, vein) and 36410 (Venipuncture, age 3 years or older, necessitating physician's skill [separate procedure], for diagnostic or therapeutic purposes [not to be used for routine venipuncture]).

You won't be paid for 36000 or 36410 if you report them along with the same PET codes above (78491, 78492, 78608, 78609, 78811-78816). Why: Again, the reasoning is that needle introduction or venipuncture is integral to the larger procedure, so you shouldn't report the smaller procedure separately. These edits also have the "1" indicator, so you may break these bundles if your documentation supports it.

Repair Your AAA Coding

Interventional radiology didn't escape the 11.2 edits: 34900 (Endovascular graft placement for repair of iliac artery [e.g., aneurysm, pseudoaneurysm, arteriovenous malformation, trauma) and 0078T (Endovascular repair of abdominal aortic aneurysm, pseudoaneurysm or dissection, abdominal aorta involving visceral vessels [superior mesenteric, celiac or renal], using fenestrated modular bifurcated prosthesis [two docking limbs]) are listed as mutually exclusive procedures. This means that if you report them together, you'll only be paid for the less extensive procedure - 0078T.

Problem: A physician may repair an isolated internal or external iliac artery aneurysm "separate from the aortic aneurysm at the same time that an aortic aneurysm is being repaired with an endograft," says Gary W. Barone, MD, vascular surgeon and associate professor of surgery at the University of Arkansas for Medical Sciences in Little Rock.

Solution: If your report shows these two procedures performed together, be sure to append modifier 59 (Distinct procedural service) to 0078T to receive payment for both.
 
More mutually exclusive edits: AAA repair code 0078T and its radiological supervision and interpretation code 0080T are also considered mutually exclusive of endovascular graft placement code 34900 and direct repair and graft insertion codes 35082, 35092, 35103, 35131 and 35132. Hidden trap: You're unlikely to see an endo- vascular and direct repair at the same time, unless the endovascular procedure fails, Barone says. And in that case, you should instead report 34830-34832 (Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated arterial trauma, following unsuccessful endovascular repair ...), he adds.

New nonmutually exclusive edits for AAA: If you report 0078T and 0080T, don't report the following codes: