Radiology Coding Alert

Indiana Subscriber

Answer: You'll find diagnostic imaging family indicators in the Medicare Physician Fee Schedule (MPFS):

01 = Family 1 Ultrasound (chest/abdomen/pelvis -- non obstetrical)

02 = Family 2 CT and CTA (chest/thorax/abdomen/pelvis)

03 = Family 3 CT and CTA (head/brain/orbit/maxillofacial/neck)

04 = Family 4 MRI and MRA (chest/abdomen/pelvis)

05 = Family 5 MRI and MRA (head/brain/neck)

06 = Family 6 MRI and MRA (spine)

07 = Family 7 CT (spine)

08 = Family 8 MRI and MRA (lower extremities)

09 = Family 9 CT and CTA (lower extremities)

10 = Family 10 MR and MRI (upper extremities and joints)

11 = Family 11 CT and CTA (upper extremities)

Resource: CMS lists these indicators in Medicare Claims Processing Manual Chapter 23, "Fee Schedule Administration and Coding Requirements" (www.cms.hhs.gov/manuals/downloads/clm104c23.pdf, page 212).

When a code's Multiple Procedure Indicator is "4," Medicare applies special rules for diagnostic imaging procedures' technical components (TC) when you bill the procedure with another diagnostic imaging procedure that has the same family indicator. The payer ranks the procedures by TC fee schedule amount and pays 100 percent for the highest priced procedure and 75 percent for each subsequent procedure.

Example: The July MPFS update lists diagnostic indicator 02 for 71250-TC (Computed tomography, thorax; without contrast material; technical component). If you report 71250-TC with another family 2 code (such as 72192, Computed tomography, pelvis; without contrast material) for the same patient on the same day, Medicare will pay you 100 percent for the higher-priced technical component service and 75 percent of the usual fee for the lower-priced service.