June 30, 2016

Q and A

Previous National Correct Coding Initiative (NCCI) edits and SIR/ACR guidance indicate that when venous sampling is performed, it is reported “once per organ sampled.” Since adequate pituitary venous sampling requires selective catheterization and aspiration of bilateral petrosal venous sinuses, what is the correct coding for this procedure? 

It is the consensus of the Economics Committees on Coding and Nomenclature and Interventional Radiology that it is appropriate to report codes 36500, 36500-59 (

Venous catheterization for selective organ blood sampling), 75893, and 75893-59 (Venous sampling through catheter, with or without angiography (eg, for parathyroid hormone, renin), radiological supervision and interpretation) when a single organ such as the pituitary is sampled from separate, selective catheterizations of the right and left inferior petrosal sinuses.  Use modifier 59 Distinct Procedural Service) or modifier XS (Separate Structure: A service that is distinct because it was performed on a separate organ/structure) in lieu of modifier 59 to distinguish the procedures are separate and distinct. As modifiers are payer specific, check with your third party payers to determine how you should report these procedures. 

An ultrasound of the liver is performed using the newly FDA–approved contrast agent Lumason. How should this be reported? [CLARIFIED 7/12/16*] 

The Ultrasound contrast agent known as Lumason has been approved by the Food and Drug Administration for use in ultrasonography of the liver for characterization of focal liver lesions in adult and pediatric patients.  The temporary Healthcare Common Procedure Coding System (HCPCS) Level II code C9457 (Lumason contrast agent) was replaced by a permanent HCPCS Level II code Q9950 (Injection, sulfur hexafluoride lipid microspheres, per ml), effective January 1, 2016. 

Given that there are no dedicated ultrasound with contrast codes, when a contrast enhanced ultrasound study of the liver is performed using Lumason, the ultrasound procedure may be reported with CPT code 76705; Ultrasound, abdominal, real time with image documentation; limited, and the injection of contrast reported with code 96374; Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug.  The reporting of 96374 is similar to the long-standing coding guidance regarding the use of contrast agents for echocardiography.  As noted in the January 2010, CPT Assistant, p. 8, the use of 96374 is appropriate for the administration of contrast material used during performance of a resting echocardiography (codes 93306, 93307, and 93308). For the injection of contrast media for imaging, code 96374, Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug, may be reported.  The ultrasound contrast agent Lumason should be reported separately using HCPCS Level II supply code Q9950 based on the number of milliliters administered.

*96374 is identified as an Incident to Code and cannot be coded by the radiologist in the in-patient and out-patient hospital place of service for Medicare patients. As noted in the National Physician Fee Schedule Relative Value File Calendar Year 2016 PC/TC Indicator, 5, = Incident To Codes--This indicator identifies codes that describe services covered incident to a physician's service when they are provided by auxiliary personnel employed by the physician and working under his or her direct personal supervision. Payment may not be made by carriers for these services when they are provided to hospital inpatients or patients in a hospital outpatient department. Modifiers 26 and TC cannot be used with these codes.