Radiology Coding Alert

Attention, Radiology Coder: You can no longer report a nonobstetric transvaginal ultrasound with a complete pelvic ultrasound because the National Correct Coding Initiative (NCCI) now bundles them.
 
NCCI Edits, version 9.3, effective Oct. 1, 2003, through the end of the year, bundles 76830 (Ultrasound, transvaginal) into 76856 (Ultrasound, pelvic [nonobstetric], B-scan and/or real time with image documentation; complete) because it is considered standard medical practice. You should report only the abdominal approach in most cases. The new edits also bundle 76830 into 76857 (... limited or follow-up [e.g., for follicles]) because the limited ultrasound is the more extensive procedure.
 
Medicare has indicated that you can bypass these edits with a modifier such as -59 (Distinct procedural service). For example, you would have to perform transvaginal ultrasound for a different reason - such as viewing a different anatomic structure like the cervix. If you use both the transvaginal and complete or limited ultrasound to view the same structures at different angles, you would not meet the definition of modifier -59 - that is, different session, different patient encounter, different incision or excision, different organ or site, separate lesion, or separate injury.

X-Ray Codes Bundled by Family

NCCI 9.3 also bundles four x-ray codes (73140, 73660, 73560 and 73562) into their related anatomic components (73120-73130, 73620 and 73565). When your radiologist performs the x-rays on separate sides, Medi-care permits you to override the edits with a modifier.   
 
You can no longer separately report a finger x-ray (73140, Radiologic examination, finger[s], minimum of two views) with a hand exam (73120, Radiologic examination, hand; two views; 73130, ... minimum of three views) on the same extremity.
 
These edits make sense, says Patricia Davis, CPC, business office supervisor and radiology x-ray technician at Middlesex Health System Primary Care in Middletown, Ct., because the hand x-ray shows all five fingers. "So no reason exists to perform a hand and finger x-ray on the same hand," she says.
 
For instance, a new patient who recently took up boxing complains of finger and hand pain on his right hand. The physician orders a hand x-ray with three views. In this case, you shouldn't unbundle the finger x-ray (73140) from the hand x-ray (73130), Davis says, because the hand x-ray includes views of the fingers. NCCI uses the same rationale to bundle a two-view hand x-ray (73120) with a finger x-ray (73140).
 
When your practice performs the finger x-ray on a different anatomic site from the hand exam, you should use modifier -59 to indicate that you performed the x-rays on separate extremities. "When NCCI bundles two procedures that occur on different body sites, you need modifier -59 to unbundle the codes," says Mary I. Falbo, MBA, CPC, president of Millennium Healthcare Consulting Inc. in Landsdale, Pa.
 
In this case, appending modifier -59 to 73140 will unbundle the finger x-ray (73140) from the hand x-ray (73120-73130).
 
Also make sure you use the proper body-side modifiers (-LT, Left side; -RT, Right side) when necessary to inform the payer that the radiologist examined different sites, Davis says.
 
Suppose the amateur boxer in our example also injures his left pointer and middle fingers. In addition to the three-view right-hand x-ray, you perform and interpret a two-view finger x-ray on the patient's left hand. You should assign 73130-RT for the hand x-ray. For the finger x-ray, you should append modifier -59 to 73140-LT to indicate that the finger exam occurs on a separate anatomic site from the hand x-ray.

Code Other-Side Toe and Foot X-Ray

As with the upper-extremity edit, you may report two lower-extremity x-ray codes, 73660 (Radiologic examination; toe[s], minimum of two views) and 73620 (Radiologic examination, foot; two views), only when your practice performs the x-rays on separate feet. Since a same-side foot x-ray will also show the toes, NCCI bundles 73660 into 73620.
 
"These edits follow the same principle as the finger-hand bundle," Davis says. You would perform either a toe or a foot x-ray, not both. Most practices are following these billing guidelines, so the bundles shouldn't affect your bottom line, she says.
 
When your practice performs knee x-rays, don't report 73560 (Radiologic examination, knee; one or two views) or 73562 (... three views) with 73565 (... both knees, standing, anteroposterior). Payers that follow the NCCI edits now consider the fee for one-three knee x-ray views (73560-73562) included in the fee for 73565.