Radiology Coding Alert

Question: I code for a hospital, and we've been receiving denials from Medicare for outpatient 74305 procedures. Should we be doing something differently?

Georgia Subscriber

Answer: Unfortunately, you shouldn't expect payment for this tube cholangiogram in Medicare outpatient cases.

Before 2008, Medicare packaged payment for the injection (47505, Injection procedure for cholangiography through an existing catheter [e.g., percutaneous transhepatic or T-tube]), but assigned a payable APC for the diagnostic imaging (74305, Cholangiography and/or pancreatography; through existing catheter, radiological supervision and interpretation). For 2008, however, CMS packaged all supervision and interpretation (S&I) services.

CMS designated 74305 as unconditionally packaged (status N). Medicare pays conditionally packaged (status Q) services if there is no other payable service on the claim, but it doesn't pay the unconditionally packaged services separately under any circumstances.

Reality check: Code 74305 should have been a status Q code (conditionally packaged) because your radiologist may perform tube cholangiograms as stand-alone procedures. CMS probably will change the code status to Q eventually, so be sure to continue reporting the code to offer CMS claims data to support the change.