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Radiology Coding Alert

READER QUESTIONS:

Don't Give Away Supplies for Free

Published on Wed Feb 16, 2005

Question: We have a new client that is a freestanding facility, whereas most of our clients are hospital-based. Can we charge extra for the supply of contrast to this facility? Are there any other supplies that we can charge for and, if so, what are the correct codes for these?


North Dakota Subscriber


Answer: Yes, you can charge this freestanding facility for the supply of contrast used for MRIs - that is, if you are reporting the global charge or the charge for the technical component.

You should report HCPCS code A4647 (Supply of paramagnetic contrast material [e.g., gadolinium]), which includes Omniscan, Prohance and Magnevist.

You can also charge for low-osmolar or non-ionic contrast, used in CT scans, arthrograms, and many other types of contrast-enhanced radiology studies. As with the MRI contrast materials, you can bill for the supply if you are billing for the global fee or technical component (not the professional component). Choose a code from A4644-A4646, depending on the amount of iodine that is in the contrast the radiologist uses.

Other supplies you can bill for this freestanding facility include:
 

  •  Sedation drugs - report the appropriate J code for any sedation drugs you provide to your claustrophobic patients as well as any sedatives, including Valium.

     
  •  Surgical trays - report A4550 (Surgical trays) when you use a surgical tray. Don't expect to be reimbursed for this expense, but you should still report this code for tracking purposes.

    Alternative: If your payer doesn't accept HCPCS Level II codes, report 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]) along with the requested list of supplies used.

    Snag: Many payers won't separately reimburse you for supplies, even if you code them properly. You need to be familiar with each of your payer's policies and procedures. Keep track of your reimbursement by policy and plan and then set up appointments with payers that  won't reimburse you, especially if you can show that their policy says they will reimburse you or their policy just isn't clear on the matter.

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