Radiology Coding Alert

Prepare for the next round of bundles with this review of 11.0 and the basics

April will bring another list of National Correct Coding Initiative (NCCI) edits you have to consider every time you code. Size up your skills with this radiology coding exam. Try Your Coding Skills Question 1: NCCI Edits version 11.0, effective Jan. 1, 2005, includes hundreds of radiology edits related to the new injection and infusion temporary G codes. The short of it is, you can't report these G codes with most radiology procedures. True or False: If a Medicare patient receives a contrast injection and then doesn't undergo the imaging exam, you may be able to report one of the G codes. Question 2: NCCI edits include mutually exclusive edits and what other type of edit? Question 3: Is there a place where you can access the NCCI edits for free? Question 4: After you've verified that you may override a code pair in a particular situation with modifier -59, which code do you append the modifier to? Find Out How You Fared Answer 1: True, says Jackie Miller, RHIA, CPC, senior consultant with Coding Strategies Inc. in Powder Springs, Ga. If the physician does not perform the imaging exam after injecting contrast, you may code for the injection by itself.

Since the very beginning, NCCI has bundled injection and infusion codes 90780-90799 into many radiology procedures, Miller says.

This means that when a patient received a contrast injection for radiographic, CT, MRI, or nuclear imaging, you could only report and get reimbursement for the imaging procedure, she says. Payers would not reimburse you separately for the injection.

Medicare replaced some of the injection and infusion codes with the temporary G codes, so the NCCI edits had to take this into account, bundling the G codes into the radiology procedures.

Stay alert: "In 2006, the CPT manual will include new drug administration codes that will replace the G codes for all payers," Miller says.

For a full explanation of the new codes, head to Transmittal 129/Change Request 3631, issued Dec. 10, 2004, available online at www.cms.hhs.gov/manuals/pm_trans/R129OTN.pdf. Answer 2: The two types of edits are "mutually exclusive" and "column 1/column 2" edits, formerly known as "comprehensive/component."
 
Mutually exclusive edits pair procedures or services that the physician could not reasonably perform at the same session on the same patient, says Kelly Dennis, CPC, EFPM, owner of the consulting firm Perfect Office Solutions in Leesburg, Fla.

The version 11.0 edits, for example, added 77427 (Radiation treatment management, five treatments) and 0082T (Stereotactic body radiation therapy, treatment delivery, one or more treatment areas, per day) to the mutually exclusive edits.

Red flag: You will lose revenue if you report [...]