February 28, 2008

ACR Radiology Coding Source™ January-February 2008 Q and A

Q: Are there new Healthcare Common Procedure Coding System codes for 2008 to describe the use of gadolinium?

A: The Healthcare Common Procedure Coding System (HCPCS) codes for payment of gadolinium were updated and became effective as of January 1, 2008. Codes A9576 to A9579 replace code Q9952 (Injection, gadolinium-based magnetic resonance contrast agent, per ml), which has been deleted. Codes for gadoteridol (A9576); gadobenate dimeglumine (A9577); gadobenate dimeglumine (multipack) (A9578); and gadolinium-based magnetic resonance contrast agent, not otherwise specified (A9579) should be used to report these paramagnetic contrast agents. As of January 1, 2007, contrast media and paramagnetic contrast agents are paid separately when used in magnetic resonance imaging and other various imaging procedures. However, it should be noted that contractors still have the authority to specify the payment guidelines of contrast materials by placing it on their local coverage determination policies. It should also be noted that as of January 1, 2008, contrast and paramagnetic imaging agents are bundled into the base procedure code under the Hospital Outpatient Prospective Payment System and will not be reimbursed separately.

Q: How is digital motion fluoroscopy reported? Is it appropriate to report the videoradiography code 76120?

A: Yes, digital motion fluoroscopy should be reported using CPT code 76120 (Cineradiography/videoradiography, except where specifically included). Because the study is recorded digitally does not negate the use of code 76120. As noted in the American Medical Association’s September 2000 CPT Assistant (p 4), both videofluorography and cineradiography are used to record motion at fluoroscopy.

Videofluorography is the recording of motion on videotape or on a digital disk from a television monitor mounted on the output port of a fluoroscopic image intensifier. Cineradiography is a motion picture recording produced by a camera attached to the output port of a fluoroscopic image intensifier. Both are methodologies for recording moving events as seen by a physician at fluoroscopy.

Q: Does the ACR have a recommendation for coding when an axillary view is done with a breast ultrasound? Would the axillary ultrasound be coded separately with 76880, or would it be included in the breast ultrasound?

A: Axillary views taken during an ultrasound study of the breast are not reported separately, as they would be considered included in the breast ultrasound study. Code 76645 (Ultrasound, breast[s] [unilateral or bilateral], B-scan and/or real time with image documentation) is used when evaluating one or both breasts for cysts or solid masses. Breast ultrasonography is typically performed with high-frequency transducers and often in conjunction with mammography.

CPT code 76880 (Ultrasound, extremity nonvascular, B-scan and/or real time with image documentation) refers to an examination of an extremity (eg, shoulder, knee) that would be performed primarily for evaluation of muscles, tendons, joints, and soft tissues. Because the axillary area is considered to be part of the upper extremity, it is appropriate to report CPT 76880 for circumstances in which the axillary study is performed to evaluate a soft tissue mass that may be present in the upper extremity where knowledge of its cystic or solid characteristic is needed.

Q: Should 71035 be reported once or twice when right and left decubitus views of the chest are performed?

A: CPT® code 71035 (Radiologic examination, chest, special views [eg, lateral decubitus, Bucky studies]) should be reported twice when both right and left lateral decubitus views of the chest are performed. To indicate to the payer that these are two separate and distinct studies, it would be appropriate to add a modifier to designate that a bilateral procedure (eg, RT, LT, 50) was performed and that this is not a duplicate charge submitted in error. Verify with your payers the appropriate modifier to use.

This code for a special view is not included in any of the other chest codes; therefore, when special views are performed, it is appropriate to report it in addition to other chest-imaging codes. It was developed to describe a special projection of the chest (eg, decubitus view, Bucky view).

The long-standing ACR position is as follows:

Unlike most other plain film chest procedures which have their own unique CPT-4 code, decubitus views (projections taken while the patient is lying on his side) and other special views (eg, Bucky studies) are categorized under a single code (ie, 71035), as it applies to decubitus views, represents a single anteroposterior view; much like a one-view chest study (71010). To put it another way, code 71035 symbolizes a single anteroposterior view of the chest taken while the patient is lying on either side. The analogy to a one-view chest exam is also reflected by the professional relative values assigned to each code. Therefore, given the nature of the procedure and the relative values assigned to it, code 71035 should be reported once for each decubitus view taken. (RBMA Bulletin, September 1992, p 22)