Radiology Coding Alert

Question: Which HCPCS code should I use to report Eovist MRI contrast?

North Carolina Subscriber

Answer: You should verify the appropriate code with your payer, but the most likely option is A9579 (Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified [NOS], per ml).

Here's why: HCPCS doesn't currently offer a specific Eovist (gadoxetate disodium) code for physician claims. (Code C9246 [Injection, gadoxetate disodium, per ml] does describe Eovist, but HCPCS guidelines state that C codes "can only be reported for facility [technical] services.")

Because you don't have a specific HCPCS code for your physician claim, you should choose a "not otherwise specified" code. CIGNA Government Services, the Part B carrier for North Carolina, for example, lists Eovist on its "Not Otherwise Classified Drug" Part B Fee Schedule (under Option 3 at www.cignagovernmentservices.com/partb/coverage/fees/index.html for the most recent listing).

Eovist, used specifically to detect lesions in the liver, is a gadolinium-based magnetic resonance contrast agent, making it a match for code A9579. Remember to include on the claim the drug's name and exact dosage given.

Potential new code: Eovist had a spot on the April 2009 HCPCS Public Meeting agenda (www.cms.hhs.gov/MedHCPCSGenInfo/Downloads/DrugBiologicalsandRadiopharmaceuticals-Agenda.pdf). There was a request for a specific code, and CMS's preliminary decision was that it would create Axxxx (Injection, gadoxetate disodium, 1ml). We'll keep you posted.