Reader Question: ABNs for Nonionic Contrast

Question: Sometimes our facility conducts radiological procedures when a medical necessity diagnosis for the use of nonionic contrast is not on file. The facility wishes to bill Medicare for all patients receiving any contrast for the ionic contrast, even if they are receiving nonionic contrast, to avoid issuing an advanced beneficiary notice (ABN). Can we bill for the lesser contrast?

Missouri Subscriber

Answer: Your suggestion of billing for ionic, rather than nonionic, contrast could be considered downcoding. You would also be falsifying the patient record by billing for something that was not used. You may want to include the medical justifications checked by a radiologist for nonionic contrast on the consent form. A copy of the signed consent goes to health information management coders. If it is not justified and the nonionic is still ordered, the patient is requested to complete an ABN. If the ABN is not completed you will likely lose the charge.

Low osmolar contrast material (LOCM), or nonionic contrast, is paid on a reasonable cost in addition to payment for the radiology procedure and is billed with revenue code 636. When billing for the other contrast material use revenue code 255. Contrast material other than LOCM may be billed separately in addition to the radiology procedure or it may be billed as part of the amount for the radiology procedure. Regardless of the billing method, charges are subject to the radiology payment limit.


- Published on 2001-02-01