Radiology Coding Alert

Learn About These Nuclear Medicine Changes

Beginning with the nuclear medicine subspecialty, you’re going to want to brief yourself on a variety of new modifier indicator “1” pairings with the following two single-photon emission computerized tomography (SPECT) codes:

• 78451 (Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic))
• 78452 (… multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection)
• Going forward, 78451 and 78452 will now bundle into a new set of eight and seven codes, respectively. Code 78451 will pair with the following code ranges:
• 78800-78804
• 78830-78832

Code 78452 has the same pairings, except for the adjustment to code range 78800-78803.

See What’s New in Interventional, Diagnostic Radiology

Next on the NCCI agenda, shift your focus to the interventional radiology subspecialty. You’re going to want to home in on these two heart catheterization codes:

• 93452 (Left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed)
• 93453 (Combined right and left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed)

Each of these codes has 16 new NCCI PTP edits to consider for coding on or beyond April 1, 2020. The (overlapping) codes with a modifier “1” indicator paired with 93452 and 93453 include:

• 36160 (Introduction of needle or intracatheter, aortic, translumbar)
• Code range 36215-+36228
• Code range 36246-+36248

Finally, don’t forget about a few key edits to consider for the following arterial inflow and venous outflow duplex scans:

• 93985 (Duplex scan of arterial inflow and venous outflow for preoperative vessel assessment prior to creation of hemodialysis access; complete bilateral study)
• 93986 (… complete unilateral study)

As of April 1, 2020, these two codes will pair with the following set of noninvasive arterial diagnostic procedures with a modifier “1” indicator:

• 93922 (Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional, Doppler waveform recording and analysis at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus volume plethysmography at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/ dorsalis pedis arteries with, transcutaneous oxygen tension measurement at 1-2 levels))
• 93923 (Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries….)
• 93924 (Noninvasive physiologic studies of lower extremity arteries, at rest and following treadmill stress testing…)

Coder’s note: “When reporting code range 93985-93986 with 93922-93924, make sure to append the unbundling modifier to the correct code set when the documentation supports both services,” says Lindsay Della Vella, COC, medical coding auditor at Precision Healthcare Management in Media, Pennsylvania. “Depending on payer, you’ll either append modifier 59 [Distinct Procedural Service] or the respective X[EPSU] modifier to the column two — or lower-valued — code, which is the 93922-93924 code range in this instance,” Della Vella advises.