Radiology Coding Alert

April 1 heralded a new set of quarterly edits from the Correct Coding Initiative (CCI), instructing radiology coders about which Medicare-covered services can be reported together. This quarter's changes, effective through June 30, 2002, are not extensive, according to Cindy Parman, CPC, CPC-H, co-owner of Coding Strategies Inc., an Atlanta-based firm that supports 1,000 radiologists and 350 physicians from other specialty areas. Nonetheless, several are noteworthy.

Among the most important, she says, is a new edit that bundles fine needle aspiration (FNA) codes, which were introduced in 2002, into most biopsy codes. CPT Codes 10021 (Fine needle aspiration; without imaging guidance) and 10022 ( with imaging guidance) are now considered by Medicare to be components of comprehensive codes 19100* (Biopsy of breast; percutaneous, needle core, not using imaging guidance [separate procedure]), 19101 ( open, incisional), 19102 ( percutaneous, needle core, using imaging guidance) and 19103 ( percutaneous, automated vacuum assisted or rotating biopsy device, using imaging guidance). "Because 19100*, 19102 and 19103 are used frequently by radiology coders, they must be aware of the policy change regarding FNA," Parman says.

Despite this modification, radiology coders still assign imaging guidance codes in addition to the procedure codes when reporting either FNA or percutaneous biopsies. These include 76095 (Stereotactic localization guidance for breast biopsy or needle placement [e.g., for wire localization or for injection], each lesion, radiological supervision and interpretation), 76096 (Mammographic guidance for needle placement, breast [e.g., for wire localization or for injection], each lesion, radiological supervision and interpretation), 76360 (Computerized axial tomographic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device] radiological supervision and interpretation), 76393 (Magnetic resonance guidance for needle placement [e.g., for biopsy, needle aspiration, injection, or placement of localization device] radiological supervision and interpretation), 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).

Also, certain transcatheter services, e.g., 37205 (Transcatheter placement of an intravascular stent[s], [non-coronary vessel], percutaneous; initial vessel) and +37206 ( each additional vessel [list separately in addition to code for primary procedure]), are bundled into endovascular graft placements (34800-34826). "Although this seems obvious, CCI Edits has made its position clear with these edits," she says.

Percutaneous angioplasty codes 35470-35476 now include 34812 (Open femoral artery exposure for delivery of aortic endovascular prosthesis, by groin incision, unilateral), +34813 (Placement of femoral-femoral prosthetic graft during endovascular aortic aneurysm repair [list separately in addition to code for primary procedure]), fluoroscopy guidance code 76003, computerized axial tomographic guidance code 76360, and magnetic resonance guidance code 76393. Likewise, 76003, 76360 and 76393 are now bundled into the 36000 series, which is used to report vascular injections.

The new liver ablation codes (47380-47382) bundle appendectomy code 44950 and guidance codes 76000, 76003, 76360, 76393, 76942 and 76986 (Ultrasound guidance, intraoperative).

"Coders should also be careful when coding 90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour), which is now bundled into a large number of radiology codes (e.g., 70552, Magnetic resonance [e.g., proton] imaging, brain [including brain stem]; with contrast material[s])," Parman warns.

She says coders working in radiation oncology should recognize that, for reimbursement for ambulatory patient classification, G0173 (Stereotactic radiosurgery, complete course of therapy in one session) is now a component of most burr hole codes (61105-61253) and stereotactic codes (61750-61770).

Finally, coders must be aware of how coding edits affect modifier -59 (Distinct procedural service). If a particular edit appears in the classification column with a superscript of 1, modifier -59 may be appended to the second code in the edit pair. Documentation should clearly show that the two services were provided for unrelated reasons or at different anatomic sites.