HCFA Fee Schedule Provides Essential Coding Information
Published on Sun Apr 01, 2001
Many coding and billing professionals view HCFAs national relative value unit (RVU) file as a tool to determine payment for Medicare-covered services. However, this document is brimming with additional information essential to proper coding such as global periods, reporting bilateral and unilateral services, and splitting procedures into technical and professional components.
HCFA updates the RVU file annually and posts it on its Web site (www.hcfa.gov). There is a lot of valuable information coders can have right on their desktop, simply by downloading the file, points out Jennifer Butler, billing operations manager with Arizona Medical Provider Services Inc., in Cottonwood, Ariz., which provides billing and management services to radiology practices in Arizona.
Directions for downloading the RVU file used for this article are on the insert accompanying this issue. The RVU file was also published in the November 2000 Federal Register. However, that version appears in a modified format, and column headings differ from those downloaded from HCFA and appearing in this story.
Columns A, B, C and D
Each column of the RVU file provides information of value to coders. The fields explained below are those that most affect radiology coding. Those that dont appear have minimal impact.
Column A lists the codes, while Column C contains abbreviated code descriptions. Column B (modifiers) identifies whether the code has a professional or technical component (modifier -26 [professional component or PC] or modifier -TC [technical component]), Butler says. If a code has both TC and PC portions and the field is blank, it generally means that the service is global. There are some exceptions to this, however, like 76012 and 76013. These codes, added in 2001 to describe vertebroplasty imaging, are listed without modifiers, but are for the professional component only.
Some codes may be reported any of these three ways, Butler notes, such as CPT 73500 (radiologic examination, hip, unilateral; one view), which appears three times in the file once with no indication in the Modifier column, once with TC and once with modifier -26. (See insert.) A radiologist who owns x-ray equipment and interprets the films would assign 73500 globally, while the radiologist who interprets the x-rays taken at a hospital-owned facility would code 73500-26.
Column D indicates the current status of the code. An A indicates the code is active, while R represents restrictions where special coverage instructions apply (e.g., carrier-priced). A status indicator D (e.g., 70541, head and neck magnetic resonance angiography) shows that it has been deleted, explains Anne Masters, a radiology coding specialist who works with Butler.
Codes designated with an I represent codes that are not valid for Medicare. Alternately, they may be reported with HCPCS Level II codes. Code 78459 (myocardial imaging, [...]
