Radiology Coding Alert

Question: What's the proper code when the radiologist places a wire localization in the right tensor fascia lateral muscle under CT guidance?


Washington Subscriber

Answer: You'll have to use an unlisted-procedure code: 27299 (Unlisted procedure, pelvis or hip joint).

Payers are notorious for denying unlisted-procedure codes, so take your best shot at reimbursement with these four tips:

1. Ask the carrier in advance if it covers the specific procedure.

2. Include a cover letter with the documentation you send to the payer. Include a short description of the procedure in plain language in the letter, and be sure the radiologist documented the medical necessity for the procedure.

3. Compare the unlisted procedure to an existing CPT procedure code, and review the accepted charges to help capture appropriate reimbursement for the unlisted procedure. The comparison code should ideally have similar work, practice expense and malpractice risk values to the unlisted procedure in question.

4. Search out other opinions on how to code and bill the unlisted procedure. Physician specialty societies, equipment vendors, and manufacturers can suggest codes to consider, but you should always check their suggestions to be sure the recommendation is correct and compliant. Also verify that any codes they recommend are not bundled with other procedures through NCCI edits.