Radiology Coding Alert

And pay attention to the SPECT edits that didn't change

With the massive radiology-related CPT changes for 2007, you probably guessed that the National Correct Coding Initiative (NCCI) edits released Jan. 1 would be overwhelming. But we've sorted through the 9,611 edits added by NCCI version 13.0, and here's what you need to know.

A large proportion of the new edits account for the guidance, mammography, and other 2007 radiology code changes that gave many codes new digits without changing their descriptors

Example: In 2006 you had to abide by this column 1-column 2 (non-mutually exclusive) edit:

Column 1                                              Column 2                                                  Modifier Indicator

76091 (Mammography; bilateral)               76090 (... unilateral)                                    0

In 2007, under 13.0, you have this column 1-column 2 edit, which reflects the change in the digits for these mammogram codes:

Column 1                                            Column 2                                                    Modifier Indicator

77056 (Mammography; bilateral)             77055 (... unilateral)                                      0

Remember: With column 1-column 2 edits, you should report the column 1 code, not the column 2 code. If you report them both, payers will only reimburse you for the column 1 code. The "0" modifier indicator means that you cannot use a modifier to break the edit.

Watch for: NCCI also adds a tremendous number of edits for intraoperative ultrasound, says Jackie Miller, RHIA, CPC, senior coding consultant for Coding Strategies Inc. in Powder Springs, Ga. Code 76986 described this service in 2006, but in 2007 you use 76998 (Ultrasonic guidance, intraoperative).

Don't Assume Functional MRI Is Always in Column 2

Version 13.0 also adds edits for 2007's new functional brain MRI codes. Along with the usual edits bundling in anesthesia and guidance, "the new edits bundle MRI (codes 70554-70555) into MRI of the brain with contrast (70552) and with and without contrast (70553)," Miller says.

"MRI of the brain without contrast (70551) is bundled into MRI without physician testing (70554), but MRI withphysician testing (70555) is bundled into 70551," she adds.

Each of the edits has a modifier indicator of "1," which means you may use a modifier to override the edit. 
 
Example: CPT guidelines tell you not to report functional brain MRI codes 70554-70555 with brain MRI codes 70551-70553 unless you perform a separate diagnostic MRI.

Pay attention: While functional brain MRIs typically fall in column 2, be sure you note that NCCI bundles a brain MRI without contrast, 70551, into a functional brain MRI that doesn't require physician or psychologist administration, 70554.

Code 96020 note: The edits also help you abide by the CPT instruction not to report 96020 with 70554. You should only report 70555 when 96020 is performed.

Check With Payer Before Breaking SPECT Edit

Despite speculation that you might see changes to SPECT/first pass imaging edits, NCCI 13.0 keeps those edits the same.

The details: NCCI edits released in April 2006 prevented payment for first pass blood pool imaging (78481 or 78483, Cardiac blood pool imaging ...) when claimed at the same time as SPECT perfusion imaging (78465, Myocardial perfusion imaging; tomographic [SPECT], multiple studies [including attenuation correction when performed], at rest and/or stress [exercise and/or pharmacologic] and redistribution and/or rest injection, with or without quantification). The edit had a "0" modifier indicator. 

But NCCI 12.2 (released July 1, 2006) changed the modifier indicator to "1," allowing you to bypass the edit with a modifier. The change is retroactive to April 1, 2006.

Some experts recommend that you report both codes of either code pair edit with an NCCI-associated modifier if you use distinct, separate, and different "cameras" to perform the two procedures.

Example: Your radiologist's documentation specifically demonstrates that the SPECT procedure consists of a SPECT perfusion imaging camera while the first-pass imaging procedure consists of a high-count-rate camera.

Societies say: The Society of Nuclear Medicine, American College of Radiology, and American College of Cardiology "coding position has not changed, we continue to recommend use of an unlisted-procedure code for first pass with MPI imaging," says Denise Merlino, CNMT, MBA, FSNMTS, coding and reimbursement adviser to the Society of Nuclear Medicine.

Example: You perform a myocardial perfusion with SPECT and a gated first pass of the left and right ventricles without multiple gated acquisition scan (MUGA). Report 78465 for the myocardial perfusion with SPECT and 78499 (Unlisted cardiovascular procedure, diagnostic nuclear medicine) for the gated first pass of the left and right ventricles.

Best bet: Ask your payer what it considers proper coding for this procedure and get the opinion in writing.

Resource: You can access NCCI updates through the CMS Web site at www.cms.hhs.gov/NationalCorrectCodInitEd/01_overview.asp. This site contains a listing of the NCCI edits by specific CPT sections and is available free for downloading to the public.