Radiology Coding Alert

Prepare for the next round of bundles with this review of 11.0 and the basics

April will bring another list of National Correct Coding Initiative (NCCI) edits you have to consider every time you code. Size up your skills with this radiology coding exam.

Try Your Coding Skills

Question 1: NCCI Edits version 11.0, effective Jan. 1, 2005, includes hundreds of radiology edits related to the new injection and infusion temporary G codes. The short of it is, you can't report these G codes with most radiology procedures. True or False: If a Medicare patient receives a contrast injection and then doesn't undergo the imaging exam, you may be able to report one of the G codes.

Question 2: NCCI edits include mutually exclusive edits and what other type of edit?

Question 3: Is there a place where you can access the NCCI edits for free?

Question 4: After you've verified that you may override a code pair in a particular situation with modifier -59, which code do you append the modifier to?

Find Out How You Fared

Answer 1: True, says Jackie Miller, RHIA, CPC, senior consultant with Coding Strategies Inc. in Powder Springs, Ga. If the physician does not perform the imaging exam after injecting contrast, you may code for the injection by itself.

Since the very beginning, NCCI has bundled injection and infusion codes 90780-90799 into many radiology procedures, Miller says.

This means that when a patient received a contrast injection for radiographic, CT, MRI, or nuclear imaging, you could only report and get reimbursement for the imaging procedure, she says. Payers would not reimburse you separately for the injection.

Medicare replaced some of the injection and infusion codes with the temporary G codes, so the NCCI edits had to take this into account, bundling the G codes into the radiology procedures.

Stay alert: "In 2006, the CPT manual will include new drug administration codes that will replace the G codes for all payers," Miller says.

For a full explanation of the new codes, head to Transmittal 129/Change Request 3631, issued Dec. 10, 2004, available online at www.cms.hhs.gov/manuals/pm_trans/R129OTN.pdf.

Answer 2: The two types of edits are "mutually exclusive" and "column 1/column 2" edits, formerly known as "comprehensive/component."
 
Mutually exclusive edits pair procedures or services that the physician could not reasonably perform at the same session on the same patient, says Kelly Dennis, CPC, EFPM, owner of the consulting firm Perfect Office Solutions in Leesburg, Fla.

The version 11.0 edits, for example, added 77427 (Radiation treatment management, five treatments) and 0082T (Stereotactic body radiation therapy, treatment delivery, one or more treatment areas, per day) to the mutually exclusive edits.

Red flag: You will lose revenue if you report two mutually exclusive codes, because Medicare will only reimburse you for the lesser-valued of the two procedures.

Column 1/column 2 edits describe "bundled" procedures. That is, CMS considers the code listed in column 2 as the "lesser" service, which is included as a component of the more extensive column 1 procedure.

If you were to report bundled (column 1/column 2) procedures for the same patient during the same session, Medicare would reimburse only for the higher-valued of the two procedures. For example, the G codes discussed in Question 1 are bundled into the more extensive radiology procedures they are an integral and necessary part of.

Answer 3: Absolutely. For a full list of the code edits, go to www.cms.hhs.gov/physicians/cciedits/. Be sure you click on the proper category - mutually exclusive or column 1/column 2.
 
And if you're looking for hospital OPPS edits, which run one-quarter behind physician edits, check out www.cms.hhs.gov/providers/hopps/cciedits/.

Answer 4: You must append modifier -59 (Distinct procedural service) to the column 2 code to indicate to the payer that the billed procedures are distinct and separately identifiable, says Beth Glenn, CPC, CMA, certified coder for Jefferson Physicians in Jefferson City, Tenn. Remember: The column 2 code represents the less extensive procedure of the code pair. 
 
Editor's note: To get more information on the proper use of modifier -59 with NCCI edits, see the February 2005 issue of Radiology Coding Alert, "Using Modifier -59 to Separate All of Your NCCI Edits? Think Again" and the Clip-and-Save feature "Let This Tool Do the Modifier Work for You."