Radiology Coding Alert

Correct Coding Initiative (CCI) version 14.0 showers you in new edits, so we've broken down the principles behind the new edits so you can see how they really affect your daily coding. Master these essentials to help avoid the hassle of edit-related denials.

CCI edits come out every January, April, July and October. The first CCI edits of the year are often the most numerous. Here's why: CCI must create new bundles for the new codes that go into effect Jan. 1.

Case in point: CCI 14.0, effective Jan. 1, bundles new neonatal initial hospital care code 99477 into a whopping 418 codes, says Frank Cohen, CMPA, of CPA Health Partners in Clearwater, Fla. If you report 99477 with scores of radiology codes, Medicare carriers will reject the 99477 charge.

More important, CCI 14.0 also offers up multiple nonmutually exclusive (or Column 1/Column 2) edits for new radiology-specific codes, such as these examples for cardiac MRI codes 75557-75564 (Cardiac magnetic resonance imaging for morphology and function ...):

Note: "M" stands for "modifier indicator."

The first edits of the year may be hefty because they bundle the usual suspects (such as needle introduction) into new codes, but don't get overwhelmed and miss out on helpful guidance on how new codes relate to each other.

Example: With the modifier indicator "0," the above edits clarify that you never should report 75559 (Cardiac magnetic resonance imaging for morphology and function without contrast material; with stress imaging) on the same day as 75561 (Cardiac magnetic resonance imaging for morphology and function without contrast material[s], followed by contrast material[s] and further sequences).

Remember, "0" means you can't override the edit. But a "1" modifier indicator means you can override an edit with a modifier when appropriate, says Maggie M. Mac, CMM, CPC, CMSCS, CCP, ICCE, consulting manager for Pershing, Yoakley and Associates in Clearwater, Fla.

Bundles often back up instructions in the CPT manual not to report two codes together.

Case in point: CCI 14.0 creates several new edits that match new instructions in the CPT manual.

Consider the following examples:

• 3-D rendering codes 76376 and 76377 are bundled into cardiac MRI codes 75557, 75559, 75561 and 75563, supporting the CPT instruction under these codes, "Do not report 75557-75564 with 76376, 76377."

• CCI bundles 90773 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; intra-arterial) into 79445 (Radiopharmaceutical therapy, by intra-arterial particulate administration), supporting the new instruction, "Do not report 79445 in conjunction with 90773, 96420."

• A new edit bundles newly listed code 0175T (Computer-aided detection [CAD] [computer algorithm analysis of digital image data for lesion detection] with further physician review for interpretation and report, with or without digitization of film radiographic images, chest radiograph[s], performed remote from primary interpretation) into the codes listed in this CPT instruction: "Do not report 0175T in conjunction with 71010, 71020, 71021, 71022, 71030."

Each of these edits has a "1" modifier indicator, so you may override them when appropriate.

When CPT publishes a code that includes radiological supervision and interpretation (RS&I), CCI drives home the point by bundling RS&I codes into the inclusive code.

Case in point: CPT 2008's gastrostomy tube coding changes show a trend toward all-inclusive codes, says Kim French, CIC, director of interventional coding and reimbursement at Crouse Radiology Associates in Syracuse, N.Y. (See Radiology Coding Alert, Vol. 10, No. 3, for more details.)

CCI drives home the point by bundling RS&I code 75984 (Change of percutaneous tube or drainage catheter with contrast monitoring [e.g., genitourinary system, abscess], radiological supervision and interpretation) into the new GI tube codes 49440-49465. The descriptors for 49440-49465 all include "under fluoroscopic guidance including contrast injection(s), image documentation and report," or very similar wording.

These edits have a "1" modifier indicator, so you may override them when appropriate.

You know to expect a long list of codes bundling fluoroscopy and other guidance codes into new surgery codes, and CCI 14.0 doesn't disappoint.

Case in point: Check out this nonexhaustive list of examples:

5. Take Advantage of CPT RS&I Instructions

When CPT offers a specific imaging code to report with the service, CCI often bundles other imaging codes into those services.

Case in point: CCI 14.0 bundles 77012 (Computed tomography guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], RS&I) into new code 32550 (Insertion of indwelling tunneled pleural catheter with cuff).

A note with 32550 in CPT directs you to report 75989 (Radiological guidance [i.e., fluoroscopy, ultrasound, or computed tomography], for percutaneous drainage [e.g., abscess, specimen collection], with placement of catheter, radiological supervision and interpretation) for 32550 imaging guidance.

CCI 14.0 also bundles 77012 and 77021 (Magnetic resonance guidance for needle placement [e.g., for biopsy, needle aspiration, injection, or placement of localization device] radiological supervision and interpretation) into new code 50593 (Ablation, renal tumor[s], unilateral, percutaneous, cryotherapy).

A note with 50593 instructs you to see 76940 (Ultrasonic guidance for, and monitoring of, parenchymal tissue ablation), 77013 (Computed tomography guidance for, and monitoring of, parenchymal tissue ablation) and 77022 (Magnetic resonance guidance for, and monitoring of, parenchymal tissue ablation) for imaging guidance and monitoring, so you should use one of these ablation-related codes instead.