Radiology Coding Alert

Question: What are the new edits applicable to RCM procedures?

New Jersey Subscriber

Answer: The latest set of Correct Coding Initiative (CCI) edits have bundled reflectance confocal microscopy (RCM) procedures into 25 other integumentary procedures. The latest set of coding edits, version 22.1, became effective April 1, 2016.

Introduced in CPT^® 2016 earlier this year, all of the RCM codes are affected. These include the following:

• 96931 – Reflectance confocal microscopy [RCM] for cellular and sub-cellular imaging of skin; image acquisition and interpretation and report, first lesion
• 96932 – … image acquisition only, first lesion
• 96933 – … interpretation and report only, first lesion
• +96934 – … image acquisition and interpretation and report, each additional lesion (List separately in addition to code for primary procedure)
• +96935 – … image acquisition only, each additional lesion (List separately in addition to code for primary procedure)
• +96936 – …interpretation and report only, each additional lesion (List separately in addition to code for primary procedure).

You will find that the RCM codes have all been bundled as Column 2/Component codes into CPT^® 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion), as well as all of the codes in the “Excision – benign lesions procedures on the skin” (11400-11471) series.

These bundles are all marked with modifier indicator “1,” which allows you to report the two codes in the bundle separately with an appropriate modifier (e.g., modifier 59) under appropriate clinical circumstances.

What is RCM procedure? Reflectance confocal microscopy involves focusing near–infrared light on the skin to detect any abnormal lesions or scar formation. The light source connects to a computer that displays the image of the tissue under examination. You will have to use these codes when your clinician interprets the result and reports the findings for each skin lesion, area of diseased or damaged tissue.

Look at this example: The patient presents with three suspicious lesions: one on the upper right arm, one on the left upper back, and one on the nose. Your clinician made the decision to biopsy the lesion on the left upper back and monitors the remaining two lesions for changes by using RCM. You would code the biopsy on the back with CPT^® code 11100, the RCM on the arm with 96931-59, and the RCM on the nose with 96934-59.

Read more: For the complete list of CCI edits, visit www.cms.hhs.gov/NationalCorrectCodInitEd.