Radiology Coding Alert

Question: Our radiologists use low osmolar contrast media (LOCM) for all patients scheduled for computerized tomography (CT), whether or not they have had a previous adverse reaction to other contrast materials. We assign A4646 for the contrast, but Im not sure which diagnosis code to report simply the code were using for the study itself?

Alaska Subscriber

Answer: More and more radiology practices are using LOCM as their standard of care, taking this action as a precaution against contrast reactions that might harm their patients. Codes A4644 (supply of low osmolar contrast material [100-199 mg of iodine]), and A4645 (supply of low osmolar contrast material [200-299 mg of iodine]), A4646 (supply of low osmolar contrast material [300-399 mg of iodine]), are reportable, depending on the amount of iodine per milliliter of contrast media solution used.

Nonetheless, Medicare will reimburse for LOCM separately only if the radiologist can demonstrate medical necessity. Low osmolar contrast is allowable only with patients who have a history of allergy to contrast material, asthma or significant cardiac dysfunction. Specific diagnosis coding guidelines will be found within local Medicare review policies and may include history of asthma or allergy; significant cardiac dysfunction, including recent or imminent decompensation, severe arrhythmia, unstable angina pectoris, infarction and pulmonary hypertension; generalized severe debilitation; sickle cell disease or history of previous adverse reaction to contrast material with the exception of a sensation of heat, flushing or a single episode of nausea and vomiting.

When LOCM is clinically indicated, the radiology practice should report a separate ICD-9 code that reflects the condition that contraindicates the use of regular contrast. Coders should recognize, however, that some payers consider LOCM included with the CT procedure and not separately payable, regardless of the patients condition. This is particularly true in instances where practices have adopted LOCM as their standard of care.

Finally, the more typical ionic or high osmolar contrast materials are not coded and billed separately. These materials are always considered bundled into the procedural code that describes the diagnostic imaging service being provided.