Radiology Coding Alert

Question: A CT scan is done after implantation of radioactive seeds to the prostate. A Foley catheter is inserted, and 55 cc of sterile water and 5 cc of Omnipaque 240 are instilled. Our coders believe that code 51600 would be appropriately assigned for the installation of the fluid, but we are not certain. We were also considering the abdomen code, but do not feel it accurately describes the service. How do we code for this procedure?

Rita Cushing
Manhasset, N.Y.

Answer: Billing 51600 (injection procedure for cystography or voiding urethrocystography) with 72193 (computerized axial tomography, pelvis; with contrast) for CT of the pelvis if only contrast images were obtained is appropriate. Code 72194 (computerized axial tomography, pelvis; without contrast material, followed by contrast material[s] and further sections) would be used to define both pre- and postcontrast CT images of the pelvis.

An abdominal code would not describe the service accurately because an abdominal scan usually shows structures from the diaphragm down to the upper margins of the pelvic bone and generally would not encompass the area you are targeting. A CT scan of the pelvis, according to Medicare guidelines, must include the entire pelvic area from the upper margins of the pelvic bone (approximately L4) to the symphysis pubis, which would include the area of the prostate. According to Medicare guidelines, malignant neoplasm of the prostate (185), is a covered diagnosis for Medicare reimbursement. Coders should note, however, that some Medicare carriers will not pay for an abdominal scan and a pelvic scan on the same day.