Radiology Coding Alert

Did you predict CCI's edits for the new nuclear medicine code?

43,006. That's the number of additions Correct Coding Initiative (CCI) 15.0 creates. But never fear. The bulk of the edits aren't directed at changing the radiology services you report together.

This round of CCI, effective Jan. 1, attacks the usual suspects -- such as including guidance codes 76942 (Ultrasonic guidance for needle placement ...) and 77002 (Fluoroscopic guidance for needle placement...) into a code whose descriptor includes imaging guidance: 55706 (Biopsies, prostate, needle, transperineal, stereotactic template guided saturation sampling, including imaging guidance). CCI also had to create new edits to reflect the changes to the hydration/infusion code digits.

But watch out: Some changes aren't as obvious. In particular, ultrasonic guidance codes 76942 and 76998 (Ultrasonic guidance, intraoperative) are bundled into new code 78808 (Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous [e.g., parathyroid adenoma]).

As CPT Changes 2009: An Insider's View explains, you use 78808 to "report an injection for radiopharmaceutical localization by non-imaging probe study. This code reflects the resources required to provide those radioactive drugs by intravenous routes prior to gamma probe localization."

"The most common use for this code is IV injection of sestamibi, which is taken up by the parathyroid and can help the surgeon locate a parathyroid adenoma when he takes gamma probe readings over the thyroid area during surgery," says Jackie Miller, RHIA, CCS-P, CPC, vice president of product development for Coding Metrix in Powder Springs, Ga.

And note that 78808 is an IV injection, unlike interstitial injection code 38792 (Injection procedure; for identification of sentinel node), which you may use when the provider injects a radioisotope and the surgeon uses a gamma probe to locate the sentinel node in the operating room.

CCI creates a mutually exclusive edit bundling 78808 into 38792, as well as into radiopharmaceutical localization codes 78800-78807.

Note: All of these edits have a modifier indicator of "1," which means that you may override the edit with a modifier when appropriate, such as when the imaging is for a separate procedure. For information on when  Medicare considers modifier 59 (Distinct procedural service) appropriate, read "Modifier 59 Article: Proper Usage Regarding Distinct Procedural Service" available at www.cms.hhs.gov/NationalCorrectCodInitEd/.