Radiology Coding Alert

Although the switch to all-inclusive codes like 49440-49442 and 49450-49452 is typically smooth, you can take a few precautions to be sure.

Marylin Brinkman, CPC, with Clarian Health in Indiana, reports not having "had a problem in the past. If we have any doubts, we have a program (Accuro) that we can run the codes in question through before we finalize the report," she says.

Another option: Implementing all-inclusive codes "for accurate coding has not been a problem with the techs. They have books with cheat sheets next to the computer if they get confused or have questions," says Kim French, CIC, director of interventional coding and reimbursement at Crouse Radiology Associates in Syracuse, N.Y.

Although the descriptions for the new codes seem straightforward, the trend toward all-inclusive codes still isn't a desirable one, French says.

The real problem spot: Payment for RS&I-inclusive codes typically falls short of payment for a procedure code plus an RS&I code. "The Medicare fee schedule database was just published, and just to illustrate how the new all-inclusive codes are affecting us, placement of a G tube has dropped from $286.34" in 2007, including guidance, to $220.76 for the 2008 RS&I-inclusive code, French says.

CPT added a couple of other RS&I-inclusive codes you should watch for:

• 49460 -- Mechanical removal of obstructive material from gastrostomy, duodenostomy, jejunostomy, gastro-jejunostomy, or cecostomy (or other colonic) tube, any method, under fluoroscopic guidance including contrast injection(s), if performed, image documentation and report

• 49465 -- Contrast injection(s) for radiological evaluation of existing gastrostomy, duodenostomy, jejunostomy, gastro-jejunostomy, or cecostomy (or other colonic) tube, from a percutaneous approach including image documentation and report.