Radiology Coding Alert

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 [...]