October 31, 2016

ACR Radiology Coding Source™ September-October 2016

Is the new HCPCS Level II code C9744 used for billing of the professional component in the hospital setting?
No, the Healthcare Common Procedure Coding System (HCPCS) Level II code C9744, Ultrasound, abdominal, with contrast (effective October 1, 2016), was created by the Centers for Medicare and Medicaid Services to report the technical component (TC) of hospital outpatient procedures for Medicare patients. This change affects the hospital TC reporting only. The professional component billing remains unchanged and will continue to be reported with CPT code 76705 Ultrasound, abdominal, real-time with image documentation; limited (e.g., single organ, quadrant, follow-up). See the September 30, 2016 Advocacy in Action for more details on the current recommended coding of contrast-enhanced ultrasound.

How is the contrast agent used for contrast-enhanced ultrasound reported?
The Centers for Medicare and Medicaid have established the Healthcare Common Procedure Coding System (HCPCS) Level II code Q9950, Injection, sulfur hexafluoride lipid microspheres, per ml, to report the contrast used for contrast-enhanced ultrasound.

Code Q9950 is a Hospital Outpatient Prospective Payment System (HOPPS) transition pass-through code, which is available for use through December 31, 2017. CMS will state how they propose to cover Q9950 in 2018 and going forward when they release the 2018 HOPPS Proposed Rule, i.e., whether they will leave as a pass-through code, move the drug to a regular Ambulatory Payment Classification or consider it bundled.

Note: Effective January 1, 2017, all claims reporting unused drugs or biologicals from single use vials and packages appropriately discarded must make use of the JW modifier. The JW modifier identifies Drug amount discarded/Not administered to any patient. In addition to the use of the modifier, providers will be required to doc­ument appropriate disposal of each single-use drug or biological in the patient’s medical record when submitting claims. The JW modifier is not used on claims for drugs in the Competitive Acquisition Program. Readers may reference the May/June 2016 ACR Radiology Coding Source and MLN Matters MM9603 for additional information on reporting of the JW modifier.

Can I report code G0297 (Low dose CT scan (LDCT) for lung cancer screening) in conjunction with codes 71250-71270 (computed tomography of the thorax) if both are performed on the same day?
It is appropriate to report a low dose computed tomography (CT) scan code G0297 in conjunction with a diagnostic contrast-enhanced CT of the thorax (71260). Since the low dose screening exam is a non-contrast exam, there will be times where findings found on that non-contrast screening exam will need to be characterized with a diagnostic contrast-enhanced CT exam.

If a low dose CT for lung cancer screening on an asymptomatic patient demonstrates an unexpected but important finding, it might be very reasonable and necessary to follow up with a diagnostic contrast-enhanced CT of the thorax later the same day to fully define the abnormality identified on the non-contrast screening exam. Findings such as enlarged lymph nodes, mediastinal or hilar mass, esophageal mass, or even an obvious lung cancer requiring further staging are all possible reasons why a radiologist might perform a contrast-enhanced exam after a non-contrast screening study later in the same day.

Note that as of October 2016, there are column one and column two CPT code edits for LDCT screening and computed tomography procedures of the thorax. There is a CCI edit in place with a modifier indicator of "1" for the code pair G0297/712601. An NCCI-associated modifier will be allowed where a finding on the screening study, described by Healthcare Common Procedure Coding System (HCPCS) code G0297, leads to an additional CT of the thorax with contrast study, described by CPT code 71260 to define that finding when performed on the same day. However, procedure-to-procedure code pair edits G0297/712500 (CT thorax without contrast) and G0297/712700 (CT thorax without and with contrast) do not allow the use of an NCCI-associated modifier to bypass the edits.