Radiology Coding Alert

Be prepared to justify separately reporting venous sampling RS&I

Code 75893 sits in the column 2 position for more than 100 procedure codes under the National Correct Coding Initiative, version 12.3. Find out why NCCI wants you to double-check your choice when you report this RS&I code.

Consider Code Descriptors to Understand Edits

Effective Oct. 1, NCCI considers 75893 (Venous sampling through catheter, with or without angiography [e.g., for parathyroid hormone, renin], radiological supervision and interpretation) a column 2 component code to these column 1 comprehensive codes:

• 36010-36015, 36120-36247, 37200-37215 (catheterization)

• 75600-75756 (aortography/angiography)

• 75894-75995 (transcatheter procedures)

• 90760 and 90765 (IV infusion)

• 92975-92997 (cardiovascular procedures)

• 93503-93561 (cardiac catheterization)

• 96409-96425 (chemotherapy administration).
 
And venography codes 75810-75891 become components of 75893.

You can use a modifier to override any of these edits (they have a "1" modifier indicator), if you can justify the need for separate venous sampling.

Code 36500 (Venous catheterization for selective organ blood sampling) becomes a component of 146 codes, including many of the same catheterization, angiography, transcatheter therapy, cardiovascular procedures, and chemotherapy codes as 75893. And 36500 also becomes a component of venography codes 75810-75891. You can overcome these edits with a modifier when appropriate.

Rationale: Since the descriptor for 75893 includes angiography, it makes sense to bundle it with many of these other codes, says consultant and radiology expert Donna Richmond, CPC, RCC, with CodeRyte in Bethesda, Md. "It would not be appropriate to code catheterization or angiogram with 75893 and 36500 unless the angiogram was being done in a different location," she says.

Hospitals, beware: "Although the organ blood sampling codes include catheterization and angiography, both codes (36500 and 75893) are nonpayable (packaged) under the Hospital Outpatient Prospective Payment System," says radiology expert Jackie Miller, RHIA, CPC, senior coding consultant for Coding Strategies Inc. in Powder Springs, Ga.

CMS has previously explained that organ blood sampling will always be performed with other procedures and therefore does not merit separate payment, she adds.

Don't Miss the Deletion

NCCI 12.3 deletes one mutually exclusive edited pair from the 70000 series -- the edit that bundled 75980 (Percutaneous transhepatic biliary drainage with contrast monitoring, radiological supervision and interpretation) into 75982 (Percutaneous placement of drainage catheter for combined internal and external biliary drainage or of a drainage stent for internal biliary drainage in patients with an inoperable mechanical biliary obstruction, radiological supervision and interpretation).

Typically, providers perform only one or the other type of drainage (either external or internal-external). A patient can have separate biliary drainage catheters placed at separate sites, and the change in the NCCI edits allows you to report these procedures separately when they are performed and appropriately documented, Miller says.

Smart: NCCI changes "always cause me to dig deeper and check for accuracy and documentation to substantiate anything we are billing," says Katherine Phelan, coder for St. John's Health System in Tulsa, Okla. You'll find all the edits online at www.cms.hhs.gov/NationalCorrectCodInitEd/.