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Radiology Coding Alert

Reporting Diagnostic Angiography? Read This First

Published on Sat Oct 09, 2004

Plus - incorporate 82 edits just for codes 76003 and 76942

The latest version of the National Correct Coding Initiative (NCCI) edits doesn't cut radiology coders any slack just because it's the end of the year. Here's the rundown on NCCI Edits version 10.3 and how it will affect your guidance and transcatheter claims.

Double-Check That Diagnostic Angiography

Before you report an angiography code with a transcatheter code, make sure you analyze these edits. Codes 75960 (Transcatheter introduction ...), CPT 75961 (Transcatheter retrieval ...), and 75970 (Transcatheter biopsy ...) now include all of the angiography codes from 75650 to 75756.

"It's a huge departure from how people are used to coding them," says Dawn Hopkins, senior manager for reimbursement with the Society of Interventional Radiology (SIR). Now, if you want adequate reimbursement "when you do a diagnostic that's converted to a therapeutic, same patient, same day, you've got to append modifier -59 [Distinct procedural service]," she adds. Modifier -59 will override the edits, and you should append it when circumstances merit separately reporting transcatheter and angiography codes.

Generally, for interventional radiology (IR), diagnostic studies are more quickly converted to therapeutic than in other specialties, so this edit doesn't correct coding for IR in the same way it does for other fields, Hopkins says. But if your payer adopts these edits, you need to report the codes properly if you want to be reimbursed.

The bottom line: Don't report diagnostic angiography along with therapeutic services if, for example, the diagnostic angiography isn't necessary because the diagnostic information is known from another test. You include angiography inherent in the therapy in the supervision and interpretation (S&I) code for that therapy.
 
If the radiologist performs a diagnostic angiography prior to the therapeutic service, and, as is often the case, uses the results to decide on the therapy, you may code for angiography S&I separately by appending modifier -59.

Check Out These Related Edits

Other radiology codes incorporate different portions of this set of angiography codes.

  • NCCI includes angiography codes 75650-75716 in 75962 (Transluminal balloon angioplasty ...) and 75992 (Transluminal atherectomy ...).

  • Angiography codes 75722-75746 are included in 75966 (Transluminal balloon angioplasty ...) and 75995 (Transluminal atherectomy ...).

  • Don't report angiography codes 75722 and 75724 with 75994 (Transluminal atherectomy ...). Only 75994 will be paid.

  • Only 75992 (Transluminal atherectomy ...) will be paid if you submit angiography code 75746 with it.

  • If you report angiography code 75756 with 75962 (Transluminal balloon angioplasty ...), carriers that adopt the edits will only pay 75962.

  • You may not report venography code 75825 with percutaneous placement code 75940. Carriers will only reimburse you for 75940.

  • Transcatheter codes 75961 and 75970 and transluminal balloon angioplasty code 75978 now include splenoportography code 75810; venography codes 75820-75880, 75889, and 75891; and percutaneous transhepatic portography codes 75885 and 75887.

    The point of all of these edits is to make sure you don't code for diagnostic services that the radiologist did not provide. You can use modifier -59 to escape these edits when the radiologist truly provides a diagnostic angiography service. Make sure the documentation supports the separate nature of the diagnostic and therapeutic services.

    Check out the Society of Interventional Radiology at
    www.sirweb.org/codeReim/correctCodingInitiative.shtml for more information. It includes a list of edits and information on CPT 2005 introductory language you can expect on this topic.

    Let the Edits Guide You

    The 10.3 edits affect more than just angiography and venography. If you code radiological S&I for surgeries, listen up. NCCI now says you can't report codes 76003 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) and 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) separately from dozens of surgical codes.

    The latest edits force coders to be as specific as possible when choosing a guidance code. More specific radiology S&I codes are still available to be used with these surgical procedures. Jeff Fulkerson, BA, CPC, CMC, senior certified coder for the Department of Radiology at The Emory Clinic in Atlanta, says the point is to ensure you use the S&I code that is connected to the surgery and that is listed in parentheses beneath the code descriptor. By and large, all of the fluoroscopic and ultrasonic guidance you use is going to be included in that specific code.

    Pay special attention to certain intravascular procedures such as stent placement codes 37207 and 37209, as well as intravascular ultrasound code 37250, and inferior vena cava interruption code 37620. Codes 76003 or 76942 won't be paid if you report them with these surgery codes.

    For the following surgery codes, don't report 76003 or 76942. Only report the specific S&I code listed under their descriptors. Your payer won't reimburse you for generic codes 76003 and 76942:

  • Digestive system: 42550, 44901, 47011, 47490, 47500, 47510, 47511, 47525, 47530, 47630, 48511, 49021, 49041, 49061, 49400 and 49423.

  • Urogenital system: 50021, 50394-50396, 51705, 51710, 55300, 58340, 58345, 58823, 58970, 59000, 59012 and 59015.

  • Nervous system: 61070, 62290 and 62291.

    Don't expect to get paid for 76003 if you report it with digestive system codes 49080 and 49081, lymphatic code 38505, urinary system codes 50080, 50081, and 50392, male genital system code 55700, and endocrine system code 60001. But code 76942 is not a part of the edits for these codes.

    Loophole: The good news is that all of the radiology edits carry a status indicator of "1," meaning you can use the proper modifiers to override the edits. But make sure the medical record justifies the use of these nonspecific guidance codes in addition to or instead of the more specific S&I codes and indicates that these codes relate to a separately identifiable procedure. You're safest if the dictated report indicates the circumstances that led to the delivery of and coding for these services.

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