Urology Coding Alert

Plus, know when it’s appropriate to bill for contrast imaging agents.

When a physician practice incorporates new technological instrumentation and/or treatment methods into the mix, the biggest challenge often rests on the shoulders of the coders to adapt to this new way of life. This point rings especially true for physician practices that integrate radiological services, such as computed tomography (CT) scans, as components of patient office visits.

“In-office dynamics of imaging within practices is constantly changing — it’s important to be prepared accordingly,” relays Kimberly Quinlan, CPC, senior medical records coder for the University of Rochester Medical Center in Rochester, New York.

Context: Although the concept seems new, some specialty practices have actually been performing CT scans in their offices for the last 15 years,” adds Barbara J. Cobuzzi, MBA, CPC, COC, CPC-P, CPC-I, CENTC, CPCO, of CRN Healthcare in Tinton Falls, New Jersey. This equipment, which is typically purchased used from a hospital or independent diagnostic testing facility (IDTF), offers providers greater diagnostic agency in treating patients and eases the burden of referring the patient elsewhere for imaging.

While the generalized coding mechanics are the same between office and facility, there are a few important variables to take into account for office-based coders who wind up integrating diagnostic radiology services into their day-to-day coding.

Dive in for a detailed breakdown of all you need to know about coding for CT scans in an office setting.

Begin With a Quick TC, PC Modifier Refresher

Before stepping into any CPT^® or HCPCS Level II coding considerations, you want to make sure you’ve grasped the concept of how the technical versus professional component pertains to an office setting.

When it comes to diagnostic radiology, you’ve got to know when to bill the respective technical or professional component — or when to bill globally. The professional component of a diagnostic radiology service involves the radiological supervision and interpretation (RS&I) of a given scan. The technical component is reserved for facilities that own imaging equipment, but do partake in the RS&I. In most circumstances involving hospital settings, the hospital will bill for the technical component and radiologists contracted with the hospital will bill for the professional component.

In order to bill for each respective component, a modifier is appended to the CPT^® code for the imaging service. These modifiers are outlined as TC (Technical component) and 26 (Professional component). For a given imaging service, the facility and the provider will append modifiers TC and 26, respectively, to individual claims under their own National Provider Identifiers (NPIs). These dynamics play out the same whether you’re coding from a physician’s office, an outpatient facility, or a hospital.

Example: Your urologist performs a CT scan in the office, using equipment your practice owns. If the urologist performs the RS&I, will bill this service with the global code, without any modifiers, since your practice also owns the equipment. If an outside radiologist performs the RS&I, you will append modifier TC to the CT scan code reported by your practice and the interpreting radiologist will append modifier 26 for their portion of the service.

Home in on Contrast Billing, Administration

Outside of anatomic site, there’s one crucial detail you must identify in order to reach the correct CPT^® code for administration of contrast. When a CT scan is performed with contrast, there should be documentation of the provider administering contrast via one of the following methods:

• Intravascular
• Intraarticular
• Intrathecal

For the purposes of imaging performed in a urology office, contrast will typically be administered intravascularly. Furthermore, the administration of contrast is an inclusive component of the respective CPT^® code.

However, while the administration is not separately billable, it’s important to keep in mind that a provider may bill for contrast imaging agents when the scan is performed in an office (or other non-hospital) setting. Your provider will typically be injecting low osmolar contrast as described by one of the following HCPCS Level II codes:

• Q9965 (Low osmolar contrast material, 100-199 mg/ ml iodine concentration, per ml)
• Q9966 (… 200-299 mg/ml iodine concentration, per ml)
• Q9967 (… 300-399 mg/ml iodine concentration, per ml)

Consider a scenario where a patient receives a CT scan with contrast and the provider injects 150 ml low osmolar contrast. In addition to the CT scan code, you’ll report Q9965 x 150 units.

Choose Carefully Between This Set of Code Ranges

The last piece of the puzzle is aligning the correct CPT^® code with the anatomic site imaged. Fortunately, this is a relatively straightforward process — even for coders who primarily code surgeries and evaluation and management (E/M) visits. You’ll typically be considering three code options: without contrast, with contrast, and with and without contrast.

In an example involving a urology in-office CT scan, you’ll primarily be working with the following CT scan codes:

• 74150-74170 (Computed tomography, abdomen …)
• 72192-72194 (Computed tomography, pelvis …)
• 74176-74178 (Computed tomography, abdomen and pelvis …)

In the case of standalone CT abdomen procedures in a urology setting, the provider will typically be evaluating kidney functioning. Keep in mind that there is no specific set of criteria that needs to be met in order to report codes 74150-74170. Instead, as advised by Clinical Examples in Radiology (Winter 2012), the standalone CT studies are “tailored to answer the clinical question at hand.”

On the other hand, you’ll find that code range 72192-72194 involves an examination of the bladder, prostate, ovaries, uterus, lower retroperitoneum, and iliac lymph nodes. However, the same principles set for CT abdomen procedures apply regarding the need to meet a specific set of anatomic criteria.

Finally, make sure not to individually report CT abdomen and CT pelvis CPT^® codes when the provider performs both scans at the same encounter. In fact, you’ll see a flag National Correct Coding Initiative (NCCI) edit with a modifier indicator of “1,” meaning that you’ll need an overriding modifier in order to report both codes for the same patient encounter. You can only unbundle this edit with a modifier in the rare instance that the provider performs both scans at separate patient encounters on the same date of service (DOS).