ACR Radiology Coding Source™ November-December 2009 Q and A

Q: In the September/October ACR Radiology Coding Source it was noted that it would not be known whether or not the HCPCS codes G0392 (AV fistula or graft arterial) and G0393 (AV fistula or graft venous) would be deleted. Have these codes been deleted for 2010?

A: Yes, the Centers for Medicare and Medicaid Services (CMS) verified in the Hospital Out-Patient Prospective Payment System (HOPPS) Final Rule the deletion of percutaneous transluminal angioplasty codes G0392 (AV fistula or graft arterial) and G0393 (AV fistula or graft venous). In place of these HCPCS “G” codes, CPT code 35475 (Repair arterial blockage) and code 35476 (Repair, venous blockage) should be reported. These procedures will be covered surgical procedures in the Ambulatory Surgical Center (ASC) setting for CY 2010.

A percutaneous transluminal angioplasty of an arterial AV fistula or graft should be reported with 35475 for the procedure and 75962 for the imaging. For a venous AV fistula or graft angioplasty, report code 35476 for the procedure and 75978 for the imaging.

Clarification of May/June 2009 ACR Radiology Coding Source on MRCP

Please note that a magnetic resonance cholangiopancreatography (MRCP) study uses maximum intensity projection (MIP) images to better delineate the bile duct and/or pancreatic duct anatomy as part of the study. In the May/June 2009 ACR Radiology Coding Source Q&A only the bile duct was specified.

Q: What HCPCS Level II code is used to report the contrast agent Eovist® used for an MRI study of the liver?

A: As of January 1, 2010, the Centers for Medicare and Medicaid Services (CMS) has established A9581 (Injection, gadoxetate disodium, 1 ml) to report the gadolinium-based contrast agent Eovist® used in the performance of a contrast-enhanced MRI study of the liver to detect and characterize lesions in adults with known or suspected focal liver disease.

The Healthcare Common Procedure Coding System (HCPCS) Level II code A9581 should be reported in both the hospital and nonhospital settings. Eovist® (gadoxetate disodium) has been identified as a new drug and is, therefore, on the Hospital Outpatient Prospective Payment System (HOPPS) pass-through list until 2013. Under HOPPS, codes that appear on the pass-through list are paid separately and not bundled into the ambulatory payment classification (APC) code. Once a code is taken off the pass-through list, payment under HOPPS is bundled into the APC payment for the procedure code and is not paid separately.

Because payment for drugs and radiopharmaceuticals under HOPPS is bundled into the procedure code for those items not on the pass-through list, it is extremely important to report and charge separately for drugs and radiopharmaceuticals even though they may not trigger additional payment, as this charge data is used by the HOPPS and by other payers to determine and set current and future payments. Potential loss of this valuable charge data could jeopardize future appropriate bundled payments.

Q: An orthopedic surgeon ordered an MRI of the knee for use in prosthetic design and for the design of custom cutting jigs. An interpretation is not necessary. However, the hospital requires that the radiologist render an interpretation. Is it appropriate for the radiologist to report he professional component of the MRI study when an interpretation is rendered?

A: When magnetic resonance imaging (MRI) scans of the knee are performed and exported for prosthesis design and/or for the design of custom cutting jigs without a request for an interpretation, it would be appropriate for the entity that owns the equipment to report only the technical component of CPT code 73721, 73722, or 73723 (Magnetic Resonance Imaging, any joint of the lower extremity) based on whether or not contrast was administered. In this scenario, no professional component (PC) should be charged. If, however, an interpretation of the study is requested, and the medical necessity of the procedure is substantiated with an order from the referring physician, then the professional component of the appropriate CPT code (73721-73723) should be reported by the radiologist that renders the interpretation.