Radiology Coding Alert

If your physician orders more than one study to confirm a patient's condition, you had better not report these tests separately because version 9.2 of the National Correct Coding Initiative (NCCI), effective July 1, bundles several bone density study codes into each other.

The NCCI now makes 76075 (Dual energy x-ray absorptiometry [DEXA], bone density study, one or more sites; axial skeleton [e.g., hips, pelvis, spine]) and 76070 (Computed tomography, bone mineral density study, one or more sites; axial skeleton [e.g., hips, pelvis, spine]) "mutually exclusive" of one another, so you cannot use any modifiers to separate the two services.

Likewise, the new NCCI Edits creates another mutually exclusive edit by bundling G0130 (Single energy X-ray absorptiometry [SEXA] bone density study, one or more sites; appendicular skeleton [peripheral] [e.g., radius, wrist, heel]) and 76071 (Computed tomography, bone mineral density study, one or more sites; appendicular skeleton [peripheral] [e.g., radius, wrist, heel]).

"Both of these bone scan edits were probably established because it would be overkill to report more than one at the same session," says Cindy C. Parman, CPC, CPC-H, principal and co-owner of Coding Strategies Inc., a Dallas, Ga.-based healthcare reimbursement consulting firm. "Medicare has been concerned for some time that physicians order multiple diagnostic tests, using one to confirm the results of another, when it may not be medically necessary to do so."

On the positive side, the NCCI will allow you to use a modifier to separate other new edits, which bundle 76070 and 76075 into 78350 (Bone density [bone mineral content] study, one or more sites; single photon absorptiometry) if both are medically necessary and distinct from one another.

Radiation Oncology Edits Affect Hospitals

The NCCI instituted several edits involving HCPCS code G0251 (Linear accelerator based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, maximum five sessions per course of treatment), bundling it into more than 30 radiation oncology codes, including 77280-77295, 77305-77328 and 77401-77416.

"G0251 describes treatment delivery for the hospital only under the Outpatient Prospective Payment System (OPPS), so this edit won't affect physicians or freestanding centers," Parman says.

Speech Therapy Services Bundled

The NCCI also institutes new edits that bundle speech therapy services into one another. Both 74210 (Radiologic examination; pharynx and/or cervical esophagus) and 74230 (Swallowing function, with cineradiography/ videoradiography) are now considered components of the radiologic speech evaluation code 70371 (Complex dynamic pharyngeal and speech evaluation by cine or video recording).

"Our carrier has never allowed us to report both the swallowing function code (74230) and the speech evaluation code (70371) for the same patient on the same date," says Laurie Dryer, SLP, a speech-language pathologist in Miami.

Most local medical review policies (LMRPs) echo this statement with such language as "HCPCS codes 70370, 70371 and 74230 describe complete procedures and should not be billed more than one time on the same patient on the same day. Only one of the stated procedure codes should be billed per patient per day." 

In addition, the NCCI now bundles both 74220 (Radiologic examination; esophagus) and 74210 into 74230. And cineradiography code 76120
(Cineradiography/videoradiography, except where specifically included) and add-on code +76125 (Cineradiography/ videoradiography to complement routine examination [list separately in addition to code for primary procedure]) are now considered components of the following swallowing tests:

 All of these swallowing testing codes inherently include cine or video recording.