Radiology Coding Alert

Finally master when to code diagnostic exams separately Don't let angiograms trip up your radiology claims. As long as you know the bundles and medical-necessity rules to watch for, you'll code angiography services like an ace.
Size Up CCI's Effect on Diagnostic Angiograms The Correct Coding Initiative (CCI) limits your angiogram coding options, but the good news is that a few of the bundles are fairly obvious. Example: You can't get paid for both a bilateral renal angiogram (75724, Angiography, renal, bilateral, selective [including flush aortogram], radiological supervision and interpretation) and a unilateral renal angiogram (75722, Angiography, renal, unilateral, selective [including flush aortogram], radiological supervision and interpretation) on the same day. The modifier indicator status is "0," meaning you can never bypass this edit with a modifier. But other edits are less clear-cut. You have to be certain that you can use a modifier to override the edit and that the documentation supports using one. Example: CCI bundles a unilateral extremity angiogram (75710, Angiography, extremity, unilateral, radiological supervision and interpretation) into a bilateral extremity angiogram (75716, Angiography, extremity, bilateral, radiological supervision and interpretation). Unlike renal angiograms, however, you can override this edit. For instance, if your radiologist performs the extremity angiograms during different encounters, you can add modifier 59 (Distinct procedural service) to 75710 -- the lesser-valued code. Also, if your radiologist examines three extremities (both legs, 75716; and one arm, 75710), you can add modifier 59 to 75710, says Sandy Fuller, CPC, compliance officer for a Texas practice. Remember: Anytime you use modifier 59, you must have documentation to support your choice, says Rehna Burge, billing analyst at North Oaks Medical Center in Hammond, La. For example, your radiologist must document that he performed these services at different encounters or different locations. "You can also bill 75716 two times, one for upper extremities and one for lower extremities, but you'll have to appeal it to get paid because most carrier systems will deny it as duplicate," Fuller adds. "But we've been successful on getting these paid upon appeal."
Get the Modifier 59 Lowdown If you use modifier 59 to override angiogram edits, you should know the rules for using it backward and forward. CCI bundles 75710 with endovascular repair (75952-75954), stent placement (75960), foreign-body retrieval (75961), peripheral angioplasty (75962), transcatheter biopsy (75970) and atherectomy (75992). Similarly, CCI bundles 75722 (Angiography, renal, unilateral, selective [including flush aortogram], radiological supervision and interpretation) with endovascular repair (75952-75953), stent placement (75960), foreign-body retrieval (75961), renal/visceral angioplasty (75966), transcatheter biopsy (75970), and renal/visceral atherectomy (75994-75995). With both code situations, you can use modifier 59 to separate these edits. First, you can use modifier 59 if your radiologist performs the services during different encounters or on [...]