Radiology Coding Alert

Question: When we perform a contrast CT study, our non-ionic contrast comes packaged in a special syringe that fits into an injector device. Is it appropriate to bill separately for the contrast, syringe and tubing?

David Hester
Santa Monica, Calif.

Answer: The cost of the high osmolar contrast material, syringe, needle, tubing, alcohol, swab, etc., is bundled into the technical component of the procedure. However, billing for low osmolar contrast material (LOCM) may be allowed, based on medical necessity in addition to the procedure because of its extraordinary higher cost. The Level II HCPCS codes used to report LOCM are A4644-A4646 (supply of low osmolar contrast material), based on the milligrams of iodine administered.

When allowable, these codes can be billed in addition to the CT scan. However, any administration of LOCM without the following codes for medical necessity may be bundled into the technical service:

Sickle-cell anemia (282.60-282.69)

Congestive heart failure (428.0)

Severe arrhythmias such as ventricular tachycardia, supraventricular tachycardia (427.0-427.2), and sinoatrial dysfunction (427.81)

Heart block, second or third degree (426.0, 426.12)

Unstable angina (411.1)

Recent myocardial infarction (410.90-410.92)

Pulmonary hypertension (416.0, 416.9)

Asthma (493.00-493.91)

Generalized severe debilitation (799.4)

History of previous adverse reaction to contrast material (defined as generalized urticaria, bronchospasm, shock, bradycardia with hypotension or rash), with the exception of sensation of heat, flushing, or a single episode of nausea or vomiting (995.0-995.2)

Note: The codes listed above are carrier-dependent. National policy issues the guidelines for disease to support medical necessity, and carriers then assign ICD-9 codes.

In some regions, reimbursement for LOCM is calculated on a per ml/cc basis. The dosage must be submitted each time the code is billed. If the units field indicates one (1) and there is no additional documentation, payment will be based on 1 ml/cc. However, this guideline may differ payer to payer, and coders should check for correct reporting procedures.