Radiology Coding Alert

Hint:  Just say no to reporting this subtraction code

Throw out your bad coding habits during spring cleaning this year: National Correct Coding Initiative version 12.1, released April 1, includes plenty of new additions to keep you from using subtraction code 76350 inappropriately.

The most recent edits bundle CPT 76350 (Subtraction in conjunction with contrast studies) with about 150 other radiology codes, including cardiac MRI codes 75552-75555, aortography/angiography codes 75600-75790, and veins and lymphatic codes 75801-75891.

These edits are nonmutually exclusive and have a modifier indicator of "0." Translation: You may not use a modifier to break the edit, and if you try to report a bundled pair together, you won't be reimbursed for 76350.

Size Up the 76350 Situation

The 76350 edits make sense--you shouldn't be billing this code any longer, says radiology coding expert Donna Richmond, CPC, RCC, a consultant with CodeRyte in Bethesda, Md.

Why? Subtraction used to be a labor-intensive manual process, which is why CPT has a separate code for it, says Jackie Miller, RHIA, CPC, senior consultant with Coding Strategies Inc. in Powder Springs, Ga. The technique removes "images of bone and soft tissue so that all that remains in the picture is the vasculature," she says. Now, software performs subtraction, so your documentation is unlikely to support reporting 76350 legitimately.

Steer Clear of 76350 for Breast MRI CAD

Pitfall: Coders may be tempted to erroneously report 76350 for other types of image manipulation, such as CAD with a breast MRI, Miller says.

Look ahead: For services performed on or after July 1, you'll be able to report this CAD service with +0159T (Computer-aided detection, including computer algorithm analysis of MRI image data for lesion detection/characterization, pharmacokinetic analysis, with further physician review for interpretation, breast MRI), assuming you meet the full requirements of the code descriptor.
 
You'll report 0159T for CAD performed in conjunction with 76093 (Magnetic resonance imaging, breast, without and/or with contrast material[s]; unilateral) and 76094 (... bilateral).

The American College of Radiology now maintains that your best coding option for MRI CAD is unlisted-procedure code 76498 (Unlisted magnetic resonance procedure [e.g., diagnostic, interventional]). Tip: Weigh the time it will take to send in the unlisted-procedure code with the required documentation against the fact that payers are unlikely to reimburse you for the code.

Note: You can download the full list of NCCI edits at www.cms.hhs.gov/NationalCorrectCodInitEd/.