Radiology Coding Alert

Summer's here and that means the next round of Correct Coding Initiative (CCI) edits is on its way. Be sure you apply these bundles July 1.

Keep an eye on your PET claims. CCI version 14.2 changes the modifier indicator for the edits bundling A4641 (Radiopharmaceutical, diagnostic, not otherwise classified) into PET imaging codes 78811-78816 from "1" to "0."

Remember: A "1" indicator means that you may override the edit in appropriate circumstances with the right modifier. A "0" indicator means you may never override the edit.

These edits will help keep you on the straight and narrow. You shouldn't be using A4641 to report a PET scan pharmaceutical, explains Kim French, CIC, director of interventional coding and reimbursement at Crouse Radiology Associates in Syracuse, N.Y.

And you wouldn't perform another nuclear study on the same day, so you would have no need to report A4641 on the same day as the PET scans, French adds.

The only approved PET pharmaceuticals are the following, says French:

• A9526 -- Nitrogen N-13 ammonia, diagnostic, per study dose, up to 40 millicuries

• A9552 -- Fluorodeoxyglucose F-18 FDG, diagnostic, per study dose, up to 45 millicuries

• A9555 -- Rubidium Rb-82, diagnostic, per study dose, up to 60 millicuries.

You use A9526 and A9555 for heart studies and A9552 for other studies, French says.

CCI 14.2 also creates a series of mutually exclusive edits for bone density studies that will limit you to reporting one study per service date.

Example: CCI now bundles 77081 (Dual-energy X-ray absorptiometry [DXA], bone density study, 1 or more sites; axial skeleton [e.g., hips, pelvis, spine]) into 77078 (Computed tomography, bone mineral density study, 1 or more sites; axial skeleton [e.g., hips, pelvis, spine]).

Remember: If you report a mutually exclusive edited pair, the payer will deny the column 1 code and reimburse you for the column 2 procedure.