Wiki Diagnostic Radiology Contrast Coding

Cbroom1

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I have a question in regards to how to report the units for Dotarem properly? I know the description of Dotarem shows the units of measure as 0.1ml, however, our radiologists report the dosing in ML. For instance, if they used 15 ML on a patient, that is what they put in their report. So, to report and charge correctly for Dotarem - are you supposed to multiple the 15ML by 10 to get 150 and then take that 150 times the price per unit of measure? And if Dotarem shows as $18 per ML - to get the correct charge per 0.1ML - I should take 18/.01 correct - for a total of $1.80 per .01ML. Is this how it should be listed in the charge system or should it be listed at price per ML? Thanks!
 
Billing is based on the HCPCS unit, which is 0.1 mL so 15 mL = 150 billing units.
Your billing system should show the fee based on the HCPCS unit ($1.80/0.1 mL) to correctly calculate the fee.
In this case, you would be billing A9575 @ 150 units x $1.80/billing unit.
 
Billing is based on the HCPCS unit, which is 0.1 mL so 15 mL = 150 billing units.
Your billing system should show the fee based on the HCPCS unit ($1.80/0.1 mL) to correctly calculate the fee.
In this case, you would be billing A9575 @ 150 units x $1.80/billing unit.
Thank you very much! That is what I thought but needed to be sure.
 
Thank you very much! That is what I thought but needed to be sure.
We are about to start billing for MRI. If it is done with contrast do we charge for it it separately with the A9575 or include it in the cost of the MRI w/ contrast code like CT scans done with contrast?
 
IV contrast for MRI and CT is separately billable in an outpatient physician-based office (technically, intravascular, intraarticular, and intrathecal - we only used oral and IV contrast). I can't speak to other sites of service.

Some payers will not pay because they use the "contrast" descriptor to insist it is bundled. The reimbursement rates are nowhere near close enough to cover performing the test plus the cost of the contrast material. The practice I worked at billed all contrast and we simply requested an operational adjustment for denials based on payer policy, once we confirmed it and had written proof of the policy.

Edited to clarify my thoughts.
 
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