Radiology Coding Alert

Plus, see when it’s appropriate to bill for contrast injection.

While typically designated to hospitals, independent diagnostic testing facilities (IDTFs), and other outpatient facilities, radiology services are becoming increasingly common in some specialty practices. For instance, otolaryngology, pulmonology, and cardiology practices are beginning to integrate computed tomography (CT) scans as components of patient office visits, when applicable and necessary.

“In-office dynamics of imaging within practices is constantly changing — and it’s important to be prepared accordingly,” relays Kimberly Quinlan, CPC, senior medical records coder for the University of Rochester Medical Center in Rochester, New York.

Historical context: “While the concept seems new, some otolaryngology practices have actually been performing maxillofacial CT scans in their office for the last fifteen years,” says Barbara J. Cobuzzi, MBA, CPC, COC, CPC-P, CPC-I, CENTC, CPCO, of CRN Healthcare in Tinton Falls, New Jersey. “In fact, there’s even a MiniCAT™ by Xoran Technologies that works as a single-function CT scanner that closely resembles dentists’ panoramic X-ray machines,” Cobuzzi explains.

While the generalized coding mechanics are the same between office and facility, there are a few important variables to take into account for office-based coders who wind up integrating diagnostic radiology services into their day-to-day coding.

Dive in for a breakdown of how in-office CT scan coding compares and contrasts to traditional diagnostic radiology services.

Begin With a Quick TC, PC Modifier Refresher

Before delving into any CPT^® or HCPCS coding considerations, you want to make sure you’ve grasped the concept of how the technical versus professional component pertains to an office setting. When it comes to diagnostic radiology, you’ve got to know when to bill the respective technical or professional component — or when to bill for it globally. The professional component of a diagnostic radiology service involves the radiological supervision and interpretation (RS&I) of a given scan. The technical component is reserved for facilities that own imaging equipment, but don’t partake in the RS&I. In most circumstances involving hospital settings, the hospital will bill for the technical component, and radiologists contracted with the hospital will bill for the professional component.

In order to bill for each respective component, a modifier is appended to the CPT^® code for the imaging service. These modifiers are outlined as TC (Technical Component) and 26 (Professional Component). For a given imaging service, both the facility and the provider will append modifiers TC and 26, respectively, to individual claims under their own National Provider Identifier (NPI). These dynamics play out the same whether you’re coding from a physician’s office, an outpatient facility, or a hospital.

Home in on Contrast Billing, Administration

Outside of anatomic site, there’s one crucial detail you’ve got to identify in order to reach the correct CPT^® code: contrast. When a CT scan is performed with contrast, there should be documentation of the provider administering contrast via one of the following methods:

• Intravascular;
• Intraarticular; or
• Intrathecal.

For the purposes of imaging performed in a physician’s practice, contrast will typically be administered intravascularly. Furthermore, the administration of contrast is an inclusive component of the respective CPT^® code.

However, while the administration is not separately billable, it’s important to keep in mind that a provider may bill for contrast imaging agents when the scan is performed in an office (or other non-hospital) setting. Your provider will typically be injecting low osmolar contrast as described by one of the following HCPCS codes:

• Q9965 (Low osmolar contrast material, 100-199 mg/ ml iodine concentration, per ml)
• Q9966 (Low osmolar contrast material, 200-299 mg/ ml iodine concentration, per ml)
• Q9967 (Low osmolar contrast material, 300-399 mg/ ml iodine concentration, per ml)

Consider a scenario where a patient receives a CT scan with contrast and the provider injects 150 ml low osmolar contrast. In addition to the CT scan code, you’ll report Q9965 x 150 units.

Choose Carefully Between This Set of Code Ranges

The last piece of the puzzle is aligning the correct CPT^® codes with the anatomic site imaged. For the sake of practicality, have a look at an example of codes that you would designate for otolaryngology practices. Fortunately, this is a relative straightforward process, even for coders who primarily code surgeries and evaluation and management (E/M) visits. You’ll typically be considering one of three codes for an imaged anatomic site: without contrast, with contrast, and with and without contrast.

In an example involving an otolaryngology in-office CT scan, you’ll primarily be working within the confines of the following CT scan codes:

• 70480-70482 (Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear…)
• 70486-70488 (Computed tomography, maxillofacial area…)
• 70490-70492 (Computed tomography, soft tissue neck…)

Code range 70480-70482 outlines a few anatomic sites in the code description, but that’s not the full story. For instance, it’s important to know that the sella (or sella turcica) includes imaging of the pituitary gland. Furthermore, code range 70480-70482 is also reported for imaging performed on the temporal bones.

You can see that the code description isn’t as generous with it comes to code range 70486-70488. A maxillofacial CT involves imaging from the maxillary sinuses to the frontal sinuses. This code range may also include imaging of the nasopharynx and the oropharynx so long as there is documentation that the study is expanded to include those sites.

Finally, code range 70490-70492 involves, as the code description states, imaging of the soft tissue of the neck. However, imaging of the larynx may be included in this code, as well. Just keep in mind that same as with 70486-70488, documentation must support the respective anatomic site imaged.