Radiology Coding Alert

Question: What is the proper HCPCS Code for non-ionic contrast injection for IV? Our patient has an allergic reaction with regular the injection, and we must use Omipaque, which costs $75 per bottle. I cannot find any proper code.

Anonymous Michigan Subscriber

Answer: Medicare covers low osmolar contrast media (LOCM) separately when guidelines are met. When administered by an intra-arterial, intravenous or intra-articular injection, one or more of the following criteria must be met for LOCM to be covered:

Previous history of adverse reaction to contrast media with the exception of heat, flushing or a single episode of nausea and vomiting (V14.8, V14.9, 995.0, 995.2);

Personal history of asthma (V07.1, V15.0, 493.00-493.91);

Personal history of severe allergies (693.0-693.9, 477.0-477.9, 995.2);

Generalized severe debilitation condition (324.0-324.9, 348.0, 348.4, 348.8, 430-432.9, 584.5-587, 797, 799.3, 850.4, 851.00-854.19);

Sickle cell disease (282.4, 282.6-282.69);

Significant cardiac dysfunction including recent or imminent cardiac decompensation, severe arrhythmias, unstable angina pectoris, recent myocardial infarction, and pulmonary hypertension (402.00-402.91, 404.00-404.93, 410.00-411.89, 413.0-414.9, 416.0, 416.1, 416.8, 416.9, 426.0-427.9, 428.0, 429.2, 429.9, 518.4).

Patient is not a hospital inpatient or outpatient.

Administered intrathecally (within a sheath in the subarachnoid space, intradural).

Medicare will reimburse 8 percent less than the amount billed to reflect the reimbursement for contrast media that was included in the technical component of the procedure performed. It is payable as a drug incident to a physicians service. The following HCPCS codes should be used to report the agent and its concentration:

A4644: supply of low osmolar contrast material (100-199 mg of iodine). Examples: Omipaque 140 or 180; Optiray 160

A4645: supply of low osmolar contrast material (200-299 mg of iodine). Examples: Omnipaque 210 or 240; Optiray 240

A4646: supply of low osmolar contrast material (300-399 mg of iodine). Examples: Omnipaque 300 or 350; Optiray 320; Herabrix 320; isovue 300 or 370.

Documentation supporting the medical necessity of this item, such as ICD-9 codes, must be submitted with each claim. Claims submitted without such evidence will be denied as being not medically necessary.

Source: This answer was provided by Cindy McMahan, CPC.