Radiology Coding Alert

2. The NCCI now bundles codes 78473 and 78483 into 78465 (Myocardial perfusion imaging; tomographic [SPECT], multiple studies, at rest and/or stress [exercise and/or pharmacologic] and redistribution and/or rest injection, with or without quantification).

3. Medicare now considers 78461 (Myocardial perfusion imaging; multiple studies [planar] at rest and/or stress [exercise and/or pharmacologic], and redistribution and/or rest injection, with or without quantification) and 78494 components of codes 78473 and 78483.

Most carriers already bundled these services into one another. The local medical  review policy (LMRP) for Triple-S Inc., Puerto Rico's Part A carrier, states, "Only one code from the group 78472, 78473, 78481, 78483 can be used on a given day, and that one code cannot be billed with any of the codes 78460 through 78469 (Myocardial perfusion imaging), 78478 and 78480."

In addition, the NCCI now bundles 78472 and 78480 into 78494. According to the June 1999 CPT Assistant , the technology described by code 78494 "provides the added benefit of three-dimensional imaging, in contrast to the two-dimensional imaging (planar) provided in the service described by CPT code 78472." Therefore, Corcoran says, it makes sense that a two-dimensional study is not included within the three-dimensional study.

NCCI now bundles 76375 (Coronal, sagittal, multiplanar, oblique, 3-dimensional and/or holographic reconstruction of computerized axial tomography, magnetic resonance imaging, or other tomographic modality) into the radiation oncology codes 77280-77295, 77305-77315, 77326-77328 and 77401-77416. "Some practices report 76375 for image fusion for radiation oncology treatment planning, but CPT states that this code should be used in addition to an imaging service, and not treatment planning," says Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc., a medical reimbursement consulting firm in Dallas, Ga.

Medicare will now deny the brachytherapy codes 77781-77784 if you report them with G0256 (Prostate brachytherapy using permanently implanted Palladium seeds, including transperitoneal placement of needles or catheters into the prostate, cystoscopy and application of permanent interstitial radiation source) or G0261 (Prostate brachytherapy using permanently implanted iodine seeds, including transperineal placement of needles or catheters into the prostate, cystoscopy and application of permanent interstitial radiation source).

This edit is an outpatient prospective payment system (OPPS) issue, so it only affects facilities, Parman says. "The prostate brachytherapy G codes already include virtually all services required to perform the seed implant," she advises, so reporting these codes together would be incorrect under any circumstances.

The new edits also bundle 51701 (Insertion of non-indwelling bladder catheter [e.g., straight catheterization for residual urine]) and 51702 (Insertion of temporary indwelling bladder catheter; simple [e.g., Foley]) into each of the obstetrical and nonobstetrical ultrasound codes (76805-76857). You can override these bundles by appending modifier -59 (Distinct procedural service), however, if your documentation shows that the catheterization was unrelated to the ultrasound.

NCCI also bundles 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) into the endoscopy codes 43231, 43259 and 45341, the angiography codes G0275-G0278, and the code for prostate volume for brachytherapy, 76873. But you can append modifier -59 to separate the services if you can demonstrate that the procedures were unrelated, either anatomically or by diagnoses.