Radiology Coding Alert

Urinary bladder study edits are a head-scratcher for radiology coders

Nuclear medicine procedures and intravenous push code G0354 bear the brunt of the latest National Correct Coding Initiative (NCCI) edits, which took effect April 1, 2005. Plus: The latest round means paying closer attention to which guidance code matches to each procedure.

Dig Through the Pages of 78730, G0354 Edits

The two codes you'll see the most in the new bundles are 78730 (Urinary bladder residual study) and G0354 (Each additional sequential intravenous push [list separately in addition to code for primary procedure]). Both are column 2 codes in column 1/column 2 edits. Translation: Insurers won't pay for 78730 or G0354 when you perform them with the higher-valued column 1 codes they're paired with.
 
Code 78730 is bundled into a number of urinary system, ultrasound, and medicine codes, which you can't unbundle, and E/M codes, which you can.

Good news: The numerous 78730 edits shouldn't be a big blow. "Code 78730 is for a nuclear study of bladder residual," which isn't something radiology coders encounter too frequently, says Jackie Miller, RHIA, CPC, senior consultant with Coding Strategies Inc., a coding and compliance consulting firm in Powder Springs, Ga.
 
Children's facilities perform the bulk of these for follow-up to recurrent urinary tract infections, most often found in girls, says Bruce Hammond, CRA, CNMT, chief operating officer of Diagnostic Health Services in Texas. The procedure is uncommon for the average department, he adds.
 
The G0354 edits shouldn't have too big of an impact, either. NCCI Edits bundles most injection/infusion codes into procedures requiring injection of radiopharmaceutical or contrast materials. The G0354 edit is probably just part of this pattern, says a California radiology coding specialist, Carrie Caldewey, RCC, CPC. You may unbundle these codes with the appropriate modifier and documentation.

Watch Your Fluoroscopy and Ultrasound Codes

NCCI bundles fluoroscopy codes 76000 and 76003 and ultrasonic guidance codes CPT 76942 and 76986 into radiopharmaceutical codes 79403 (Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion) and 78804 (Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent[s]; whole body, requiring two or more days imaging). This bundle means you won't be paid for the column 2 guidance codes if you report them with the column 1 radiopharmaceutical codes.

Radiology coders rarely connect 79403 (assigned for the therapeutic administration of Zevalin and Bexxar) with guidance codes, so this edit shouldn't have a big impact, Hammond says. Previously, payers did cover guidance for 78804, depending on the diagnosis, he adds.

Note: You may unbundle these codes if you truly have two separate procedures and append the proper modifier.

Many of the other edits simply correct common coding errors, says Jeff Fulkerson, BA, CPC, CMC, coder for the radiology department of The Emory Clinic in Atlanta. Example: Code 76986 (Ultrasonic guidance, intraoperative) is bundled into 36597 (Repositioning of previously placed central venous catheter under fluoroscopic guidance). Code 36597 includes a note to report fluoroscopic guidance using 76000 (Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]), so the edit simply reinforces accurate coding guidelines, which say to use the listed guidance code to cover all imaging.

Tip: Radiation oncology coders should take note of the edits for 0061T (Destruction/reduction of malignant breast tumor including breast carcinoma cells in the margins, microwave phased array thermotherapy, disposable catheter with combined temperature monitoring probe and microwave sensor, externally applied microwave energy, including interstitial placement of sensor). Code 0061T is now bundled into mastectomy codes 19140-19240. Because these edits have a modifier indicator of "1," you may unbundle these with the appropriate modifier when you have documentation of a separate patient encounter or the physician performs the procedures at separate (noncontiguous) anatomic sites.

Note: For the complete list of edits, check out www.cms.hhs.gov/physicians/cciedits/default.asp.