Question BILLING ORAL AND IV CONTRAST

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The hospital I work work constantly bills Q9963 for oral contrast along with Q9967 for intravenous contrast, thus creating an edit on Q9967 that a modifier is needed. It is my understanding that when done in conjunction, that Q9963 should not be billed. Payers are denying both Q9963 and Q9967 without the modifier on Q9967. I have searched and searched with no answer.
 

trarut

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I billed physician-based radiology for several years and we never billed for oral contrast, only ever for the IV contrast. It's always been my understanding that oral contrast is an inherent part of the imaging procedure, making it bundled.
 
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trarut, this is exactly what I have been saying, but our facility continues to want to bill them both since they were both used. It is not appropriate to append a 59 modifier to Q9967 since it was done at the same time as part of the same procedure.
 

thomas7331

True Blue
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I think you are correct that Q9967 should not be billed without documentation to support a modifier indicating a separately identifiable procedure done at the encounter. However, even with a modifier or removing the charge for Q9967, you are still unlikely to get a separate payment for the other contrast charge. Under OPPS, Medicare packages these charges into the APC case rate for the radiological procedure or other services performed at any hospital encounter, and I imagine that this is likely the case with your non-Medicare payers as well. For facility claims, most payers do not pay a separate itemized rate for contrast. So I think it unlikely that your facility's practice of billing these two charges together is having an impact on the final payment.
 
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