Good Morning:
If I am reading your question correctly, I would have 1 question and 1 recommendation.
1. Is the postoperative chest x-ray being performed only to "confirm placement" of the pacemaker and are you only billing modifier -26 for the technical component? If not, I believe this would fall under the "confirmatory" placement guidelines and you would not bill separately for the procedure.
Recommendation: According to ICD-10-CM Official Guidelines for Coding and Reporting FY 2022, Section I.C.21.c.7 (Aftercare), Status Z codes may be used with aftercare Z codes to indicate the nature of the aftercare. For example, code Z95.1, Presence of aortocoronary bypass graft, may be used with code Z48.812, Encounter for surgical aftercare following surgery on the circulatory system, to indicate the surgery for which the aftercare is being performed. A status code should not be used when the aftercare code "indicates the type of status, such as using Z43.0, Encounter for attention to tracheostomy, with Z93.0, Tracheostomy status. I believe the same rule would apply here. If you are assigning Z95.0, you would not need the Z98.890 for the postprocedural status.
Question 1:
Coding Clinic for HCPCS, First Quarter 2018: Page 3:
Confirmatory Chest X-ray
QUESTION 1
Please clarify if the coding instruction provided in AHA Coding Clinic for HCPCS 3Q 2015 and Coding Clinic for HCPCS 2Q 2014 continues to apply in 2017 as it relates to hospital-based NCCI edits for chest X-rays that are used to confirm placement of endotracheal tubes or chest tube insertions. Is it appropriate for the hospital to report 31500 and 71010-59 when the chest X-ray is used to confirm placement of the ET tube? These code pairs are listed in the 2017 NCCI PTP edits as a misuse of column 2 with column 1 code. So in what circumstance is it not appropriate for the hospital to report a chest X-ray with modifier 59 when an ET tube is inserted?
The CMS NCCI Policy Manual Chapter 9 was updated effective 1/1/2017 to include the following language in section C.3: When a comparative imaging study is performed to assess potential complications or completeness of a procedure (e.g., post-reduction, post-intubation, post-catheter placement, etc.), the professional component of the CPT code for the post-procedure imaging study is not separately payable and should not be reported. The technical component of the CPT code for the post-procedure imaging study may be reported.
However, the NCCI Policy Manual Chapter 9 Section C.9 states: When a central venous catheter is inserted, a chest radiologic examination is usually performed to confirm the position of the catheter and absence of pneumothorax. Similarly when an emergency endotracheal intubation procedure (CPT code 31500), chest tube insertion procedure (e.g., CPT codes 32550, 32551, 32554, 32555), or insertion of a central flow directed catheter procedure (e.g., Swan Ganz) (CPT code 93503) is performed, a chest radiologic examination is usually performed to confirm the location and proper positioning of the tube or catheter. The chest radiologic examination is integral to the procedures, and a chest radiologic examination (e.g., CPT codes 71045, 71046) should not be reported separately.
Please clarify this guidance for us.
ANSWER
The guidance provided in the CMS NCCI Policy Manual, Chapter 9, Section C.3, differs from the guidance provided under Section C.9. Section C.3, represents "comparative imaging studies" and Section C.9, represents "confirmatory imaging." Section C.3 was updated to clarify the correct reporting of comparative imaging services. Instead of stating, "This requirement does not apply to OPPS services reported by hospitals," the guidance was modified to clarify that "The technical component of the CPT code for the post-procedure imaging study may be reported."
Please note, however, that in Section C.9, the guidance did not change. Chest imaging performed to confirm the location and proper positioning of a tube or catheter would not be separately reported.