Radiology Coding Alert

1 handy chart offers all the details on 7 can't-miss updates

Keeping up with all the coding news at this time of year is a real chore, but don't despair. The summaries below will help make sure you don't miss a radiology coding beat.

1. 2007 Multiple Exam Payment Reduction: Imaging centers will find some good news in CMS' 2007 Medicare Physician Fee Schedule proposed rule. CMS is keeping the 25 percent technical-component payment reduction of additional related imaging exams performed on the same day, instead of increasing the discount to the proposed 50 percent. (Example: You perform a CT of the abdomen and pelvis on the same patient. The carrier covers the pelvis at 100 percent and discounts the lower-paying abdomen by 25 percent.)

See the CMS press release on these changes at www.cms.hhs.gov/apps/media/press/release.asp?Counter=1943.

2. ICD-9 Red Alert: You may not switch out your CPT and HCPCS manuals until Jan. 1, but make sure you grab the 2007 version of ICD-9, starting Oct. 1. See proposed ICD-9 changes on the CMS Web site at www.cms.hhs.gov/AcuteInpatientPPS/downloads/cms1488p.pdf in table 6A, and in the June 2006 Radiology Coding Alert article "ICD-9 Update: Be the First to Know Next Year's New Codes."

3. Help for Modifier 25: You can never get enough information when it comes to properly using modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).

CMS recently clarified how to use 25 during a surgery global period. The gist: Carriers won't pay for an E/M service reported with a procedure that has a global fee period unless you append modifier 25 to the E/M service, designating it as a "significant and separately identifiable E/M service from the procedure." With the exception of arteriograms and venograms, most interventional radiology procedures have global periods.

You'll find the MLN Matters article MM5025, "Payment for Evaluation and Management Services Provided During Global Period of Surgery," at www.cms.hhs.gov/MLNMattersArticles/downloads/MM5025.pdf.

4. Make Room for MUEs: CMS almost scrapped the controversial medically unbelievable edits (MUEs) but instead renamed them medically unlikely edits.

The approximately 2,800 new edits are designed to test particular codes against a maximum number of units of service. These edits will auto-deny or auto-suspend any claims in which the units exceed the maximum.

Note: You can't bill your patient for any excess charges denied by the MUEs, CMS says. You also won't be able to appeal these denials.

5. Brachytherapy: CMS proposes to give brachytherapy codes 77781-77784 (Remote afterloading high-intensity brachytherapy ...) "XXX" global periods to allow you to bill separately for each treatment session. But CMS will lower the work RVUs for those codes to reflect that you can bill separately for a post-operative visit. Note: This proposal affects brachytherapy only--not external beam radiation.

6. Screening tests: Starting in January, Medicare will cover a one-time ultrasound screening for abdominal aortic aneurysms (AAA), along with the "Welcome to Medicare" exam.

Patients should be male, between 65 and 75, and have a family history of AAA or a personal history of smoking. CMS will create a new "G" code with the same values as ultrasound code 76775 (Ultrasound, retroperitoneal [e.g., renal, aorta, nodes], B-scan and/or real time with image documentation; limited).

7. Manual Update for PET Practitioners: Effective for services performed on or after Jan. 1, 2006, report A9555 (Rubidium Rb-82, diagnostic, per study dose, up to 60 millicuries) instead of Q3000, and A9552 (Fluorodeoxyglucose F-18 FDG, diagnostic, per study dose, up to 45 millicuries) instead of C1775. CMS previously addressed the change for FIs but only recently updated carrier manuals.

You can read more at www.cms.hhs.gov/MLNMattersArticles/downloads/MM5054.pdf (Procedure Coding System [HCPCS] Codes Applicable to Positron Emission Tomography [PET] Scan Services for Carriers).