Radiology Coding Alert

Find out which new angioplasty codes are under the NCCI microscope

Step outside the 70000-range radiology-coding box, and you'll see dozens of new National Correct Coding Initiative edits affecting your coding this spring. Try these expert tips on recognizing legitimate opportunities to override edits when your provider performs separate, complete, medically necessary procedures.

Do You Know When 59 Trumps UT Edits?

NCCI version 13.1, which takes effect April 1, 2007, for physician claims and July 1, 2007, for hospital claims, bundles the following procedures into replacement (50382) and removal (50384) of an internal ureteral stent, says Jackie Miller, RHIA, CPC, senior coding consultant for Coding Strategies Inc. in Powder Springs, Ga.:

 • Replacement of externally accessible ureteral stent (50387)
 • Injection of renal pelvis (50390)
 • Percutaneous nephrostomy (50392, 74475)
 • Placement of ureteral stent (50393, 74480)
 • Nephrostogram injection (50394)
 • Replacement of ureteral stent via ileal conduit (50688).

You should bundle the following procedures into replacement of externally accessible ureteral stent (50387) under NCCI 13.1, Miller says:
 • Percutaneous nephrostomy (50392, 74475)
 • Placement of ureteral stent (50393, 74480)
 • Nephrostogram injection (50394)
 • Dilation of nephrostomy tract (50395, 74485)
 • Change of nephrostomy tube (50398)
 • Change of ureteral stent via ileal conduit (50688).

NCCI 13.1 bundles the following procedures into nephrostomy tube removal under fluoro guidance (50389), she says:
 • Placement of ureteral stent (50393)
 • Nephrostogram injection (50394)
 • Fluoro guidance (77002).
 Finally, replacement of internal ureteral stent (50382) is bundled into stone extraction via nephrostomy (50080, 50081), Miller says. 
 
Note: All of these edits have a modifier indicator of "1," which means you can use a modifier, such as 59 (Distinct procedural service), to bypass the edit. Modifier 59 tells the payer that the procedures were not components of one another but were both medically necessary and separate from one another, says Heather Corcoran, coding manager at CGH Billing Services in Louisville, Ky.

3 Urinary Tract Edits That Could Trip You Up

The most problematic of all the new urinary code edits will be those for the percutaneous urinary tract procedures, such as ureteral stents and nephrostomy, Miller says.
 
You may be accustomed to reporting these code pairs together when providers perform the following services, Miller says:
 
1. different procedures on each side simultaneously for patients with drainage tubes on both the left side and right side
 
2. several therapeutic procedures on one side during the same encounter
 
3. a diagnostic study (antegrade pyelogram or nephrostogram) before stent or catheter placement.
 
Because all of these edits are modifier status "1," you need to evaluate each case individually to determine whether overriding the edit is appropriate, she says.
 
Example: With NCCI 13.1, you may report 50394 (column 2) along with ureteral stent replacement (50382 or 50387; column 1) only when the documentation supports a complete, medically necessary diagnostic contrast exam followed by the therapeutic procedure (stent replacement), Miller says.
 

Don't code the nephrostogram (50394) for planned routine replacement of a ureteral catheter (50387) because the preliminary imaging is part of the catheter change. If the patient presents for diagnostic contrast exam (50394) and stone removal, code both the nephrostogram (50394-59) and the ureteral catheter replacement, as well as the stone removal, Miller says.
 
Old way: For a PCNL report, you could report 50387 for a documented stent exchange and 50394 for the documented antegrade pyelogram, says Kim French, CIC, director of interventional coding and reimbursement at Crouse Radiology Associates in Syracuse. You didn't have to append 59.

Clean Up G0392, G0393 Claims

New angioplasty HCPCS codes didn't escape NCCI 13.1 notice. Note: Unless indicated otherwise, these edits are modifier status indicator "1," which means you may override them with a modifier when appropriate. 
 
NCCI now bundles PTA of a dialysis fistula (G0392, G0393) into the corresponding regular PTA code (35475, 35476), Miller says. You may use a modifier to override the edits when PTA is performed in a dialysis fistula and in a separate vessel on the same day, she adds. Remember: "Per SIR guidelines, PTA of the outflow vein is included in the dialysis fistula PTA," Miller says.
 
NCCI 13.1 bundles the following procedures into arterial (G0392) and/or venous (G0393) PTA of a dialysis fistula, Miller says:

 • Anesthesia (01924, 01930) (Note: This edit is modifier indicator "0"; you can't override the edit with
a modifier.)

 • Venous catheterization (36000, 36005)

 • Thrombin injection for pseudoaneurysm (36002)

 • Venipuncture (36410)

 • Mechanical thrombectomy (37184) (Note: Use 36870 when mechanical thrombectomy is performed in a dialysis fistula, Miller says.)

 • Transcatheter non-thrombolytic infusion (37202)

 • Continuous epidural injection (62318, 62319)

 • Brachial plexus injection (64415, 64416)

 • Axillary nerve injection (64417)

 • Other peripheral nerve injection (64450)

 • Facet joint injection (64470, 64475)

 • Ultrasound guidance (76942, 76998)

 • Fluoro guidance (77002)

 • Injections and intravenous infusions (90760, 90765, 90772, 90774, 90775)

 • Moderate sedation by same physician (99143, 99144) (Note: This edit is modifier indicator "0"; you can't override the edit with a modifier.)

 Don't miss: "Intraoperative ultrasound (76998) is bundled into arterial (35475) and venous (35476) PTA, and injection for venogram (36005) is bundled into venous PTA (35476)," Miller says.

Prevent AVF/Non-AVF Denials -- Here's How

Keep an eye out for cases in which the provider performs an AVF angioplasty along with a separate non-AVF angioplasty, Miller says.
 
Example: "You can legitimately report G0393 and 35476 if the physician does PTA of the dialysis fistula and also of the brachiocephalic vein," but now you need to remember to put modifier 59 on G0393, Miller says.
 
Most of the other edits for the new G codes prevent you from unbundling anesthesia and contrast administration, both of which the PTA includes, she adds.