Cardiology Coding Alert

Question: I had to send claims to another state's workers' compensation program, and I received a denial for LOCM (Omnipaque 300) using Q9967. Which code should I use?

Nebraska Subscriber

Answer: You'll need to check that state's workers' compensation (WC) fee schedule. Many programs update their fee schedule only once every few years, and the low osmolar contrast (LOCM) codes have changed several times in recent years.

For the concentration you used, HCPCS 2009 shows Q9967 (Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml), which went into effect in 2007. The payer may want you to use Q9949 (Low osmolar contrast material, 300-349 mg/ml iodine concentration, per ml), which went into effect in 2005. Some coders report their programs request codes from even longer ago, such as A4646 (Supply of low osmolar contrast material 300-399 mg of iodine).

Keep in mind: The "standardized transactions and code sets" requirement of the Health Insurance Portability and Accountability Act (HIPAA) applies to all payers and providers. Reminding these WC payers of their requirement to utilize the mandated, current code set may stimulate more rapid adoption of the new codes.