Wiki Which HCPCS is used for Conray 60 for Arthrogram?

[jbaird]

How would you code for the Arthrogram mixture of contrast?

"a mixture prepared using 0.1 cc Magnavist gadolinium contrast, 10 cc preservative free saline, and 10 cc Conray 60 iodinated contrast at a 1:200 dilution was administered without incident under real-time fluoroscopic observation. 15 cc total administered volume."

A4216 with 1 unit for the 10cc saline
A9579 with 1 unit for the 0.1cc Magnevist
Unsure of HCPCS for the Conray 60??

Thanks!

 

[msreddoch]

The HCPCS code for Conray 60 (iothalamate meglumine injection USP 60%), a high-osmolar contrast material, is

• Q9961: High osmolar contrast material, 250-299 mg/ml iodine concentration, per ml

Conray 60 contains 282 mg/mL of organically bound iodine.
Conray 60 is a high-osmolar contrast medium. Always verify with the payer’s policy, as coverage and billing rules can vary.
I'm just curious: Was this a CT Scan Arthogram with a follow-up MRI Arthogram Scan? Conray 60 is a contrast that is not used much in medical imaging anymore and that is a very interesting combination of contract materials.

 

[jbaird]

This was for an arthrogram injection into the shoulder joint followed by an MRI. I agree, I thought it was unusual. I was looking at Q9958 because of the 'up to 149', but not having seen Conray in about 20 years of coding arthrograms I wanted to be sure. Do you agree with my units for A4216 and A9579? I wanted to make sure I do all of the units correctly for all 3 codes. Thank you so much!!

 

[msreddoch]

I agree with the other 2 codes, but I work for a Level 1 trauma center, so we don't bill out for the saline, just the contrast. If you are in an outpatient imaging center, I can see billing for the saline.
I was so shocked to see Conray 60 being used. I am an x-ray tech too and used to do the old-school arthrograms. The CT/MRI became the "gold standard" study for arthrograms 20 years ago. I am curious to see if this exam gets flagged for review/denial since arthrograms are not the go to exam anymore. The tech in me is wondering if the did the study to see the joint space in motion under fluro and then to MRI, which makes the most sense.