April 30, 2016

Q and A

For PQRS Measure #145 (Exposure Time Reported for Procedures Using Fluoroscopy), there is inconsistency between the Numerator Statement and the Code Descriptor for codes G9500 and G9501. Is it “radiation exposure indices, or exposure time and number of fluorographic images” or “radiation exposure indices, exposure time or number of fluorographic images?"
The Centers for Medicare & Medicaid Services’ guidance for the Physician Quality Reporting System (PQRS) Measure #145 is to report G9500 or G9501 if the final report either contains radiation exposure indices or exposure time AND number of fluorographic images. Because the wording of the final measure cannot be revised at this time, CMS published an FAQ that states:

For 2016 PQRS, the final report would need to include radiation exposure indices, or exposure time AND number of fluorographic images in order to meet performance for Measure #145. The Numerator Statement found with the measure: Final reports for procedures using fluoroscopy that include radiation exposure indices or exposure time and number of fluorographic images (if radiation exposure indices are not available) correctly describes what should be reported. It is appropriate to report G9500 if the final report either contains radiation exposure indices or exposure time AND number of fluorographic images.

Additionally, the definition for image count includes only images that require additional exposure to ionizing radiation, not those that are captured electronically from the imaging chain without additional exposure.

A group of radiologists currently has a contract for services with a provider to read the film that is generated for clients of the provider. A second group of radiologists has approached the provider and offered to review the same films through the peer-review process. Do the current ACR guidelines or other applicable rules prohibit the second radiology group from reviewing and billing for that review on the same clients?
The ACR policies do not cover peer-review billing. The ACR is not aware of any government or private payer that reimburses groups for doing their own peer-review reads. Under RADPEER, the peer-review reads are done within the practice as a quality assurance/quality control (QA/QC) measure, and not billed at all. It certainly would be possible for a radiology practice to contract out the peer-review function to another group and pay that other group for the peer-review function. It could also be done on a reciprocal basis, with each group doing peer-review reads on the other group’s images and reports with no payment in either direction. A hospital or payer could contract with an outside radiology group to do peer-review reads on an in-house or contracted hospital radiology group as a QA/QC measure. A hospital or payer might use the results as a quality measure in determining the value of the group’s work under the transition from volume to value. Done in these ways, such activities are permissible under the Health Insurance Portability and Accountability Act.

Note that when billing Medicare for second reads or over reads, Medicare administrative contractors will pay for only one interpretation, the first one submitted. The second interpretation provided by another provider, designated with modifier -77, will only be paid under "unusual circumstances” showing medical necessity.

Does PQRS Measure #405 (Appropriate Follow-up Imaging for Incidental Abdominal Lesions) apply to CT, MRI, and ultrasound as listed in the denominator or only to CT as indicated in the Code Descriptor for G9547, Incidental CT finding: Liver lesion ≤ 0.5 cm, Cystic kidney lesion < 1.0 cm or Adrenal lesion ≤ 1.0 cm?
The Physician Quality Reporting System (PQRS) Measure #405 (Appropriate Follow-up Imaging for Incidental Abdominal Lesions) applies to computed tomography, magnetic resonance imaging and ultrasound modalities as listed in the Denominator and denoted by codes 74150, 74160, 74170, 74176, 74177, 74178, 74181, 74182, 74183, 76700, 76705, 76770, 76775. For more information, see CMS PQRS Measure 405 FAQ.

Additional PQRS measure changes can be viewed on the ACR PQRS web page in the section titled "What Measures Are Most Relevant to a Radiology Practice?”.

Code 50393, Introduction of ureteral catheter or stent into ureter through renal pelvis for drainage and/or injection, percutaneous, has been deleted. How do you code for the radiologist doing percutaneous catheter placement through the renal pelvis and down into the bladder prior to the patient going for lithotripsy? In the past, we used 50393, but not sure since the replacement codes state placement of ureteral stent.
According to the parenthetical in the CPT 2016 code book, Professional Edition, p. 322 (50393 has been deleted. To report ureteral catheter placement, see 50693, 50694, 50695). The historic term 'ureteral stent' is a catheter - not a metallic body, and therefore appropriate to use for a catheter placement. Codes 50693, 50694 and 50695 are therapeutic procedure codes describing percutaneous placement of ureteral stents that include access, drainage, catheter manipulations, diagnostic nephrostogram and/or ureterogram, when performed, imaging guidance (eg, ultrasonography and/or fluoroscopy), and all associated radiological supervision and interpretation.

Please note that code 50693 should be used if a pre-existing access to the kidney is present; code 50694 should be used if new renal access is acquired; and code 50695 should be used if a new renal access is acquired and a separate nephrostomy tube is also placed.