Wiki Modifer for Drugs?

[GRANNAN]

Can anyone tell me what the approriate modifier would be for contrast-Q9967?
patient was given contrast both intravenously and orally. Same HCPCS for both, but different NDC#s and dosage amounts. Optima insurance has rejected both charges indicating they want a modifier. I have been in coding
for 13 years and have never had a claim rejected because of a requirement of a modifier on a drug charge.

Thanks.

 

[jkayser]

Hi, please see the Administration of Contrast Material(s) section under the CPT book's Radiology Guidelines. It states:

"Oral and/or rectal contrast administration alone does not qualify as a study "with contrast."

Per the CPT guidelines, the phrase "with contrast" is restricted to intravascular, intra-articular or intrathecal administration.

Here is a link to the CMS guidelines and you can search for LOCM:
http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c13.pdf

Here is a related forum discussion that mentions the problem with the oral contrast:

https://www.aapc.com/memberarea/forums/showthread.php?t=12546

I hope these are helpful.

Jean Kayser CPC CIRCC