Radiology billing codes, services

CPT CODE AND Description

76770 - Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete - Average fee amount $100 - $130

76775 - Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; limited

76776 - Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation

Indications and Limitations of Coverage and/or Medical Necessity

Retroperitoneal ultrasound studies represent the ultrasonic imaging of retroperitoneal organs for the diagnosis and management of abnormalities that occur in the retroperitoneum.

A complete study visualizes all the structures or organs within the anatomic description of that study. A limited study involves a single quadrant or a single diagnostic problem or an evaluation of an organ of interest.

Retroperitoneal ultrasonography may be considered reasonable and necessary for the diagnosis and treatment of the following areas:

1. Pancreas

2. Abdominal aorta - Ultrasound is accurate for aortic measurement and may be used to follow patients with aneurysms.

3. Inferior vena cava- Ultrasound is useful in detection of invasion by adjacent tumors and identification of obstruction levels.

4. Kidneys, ureter, and bladder:

a) Kidneys-

i) To evaluate obstruction in symptomatic patients and for guidance of percutaneous nephrostomy tubes. May also confirm scarred or small kidneys in chronic renal cortical disease (but may be of no use in detecting early or mild cortical disorders or to categorize specific types of cortical diseases).

ii) May be useful in detecting and following renal cysts and localizing solid masses.

iii) May be useful as a primary diagnostic tool in patients with hematuria.

b) Ureter- Ureters are usually not well visualized by ultrasound, especially in their mid-portions; ultrasound may rarely be helpful to confirm the presence of dilatation, filling defects or a mass, in its most proximal or distal portions. Ultrasound has no role in vesicle ureteral reflux.

c) Bladder- Tumors of the bladder are most efficiently followed by cystoscopy and urography. However, ultrasound is useful in following intraluminal bladder tumor with or without extraluminal extension, including evaluation of bladder wall thickness and irregularity.

5. Renal transplants- Ultrasound is indicated to detect urinary obstruction, fluid collection, and complications of renal transplants and is considered a primary tool in this endeavor. The presence or absence of signs and symptoms dictate utilization frequency of this modality for renal transplants.

6. Adenopathy- CT is far more accurate than ultrasound in detecting and delineating adenopathy. Ultrasound in this instance should be considered secondary and rarely utilized in the detection or follow up of nodal disease.

7. Prostate- Evaluation of the prostate is primarily done transrectally by ultrasound.

8. Adrenal Gland- Ultrasound is of little value since CT scan is considered more accurate.

9. Organs located in the retroperitoneal region-Ultrasound may be helpful in evaluation of wounds, contusions, and lacerations of organs located in the retroperitoneal region.

Examples of Claim Adjudication Scenarios: Preventive vs. Diagnostic:

1. Member is a 65 year old male with previous history of smoking and is scheduled for an abdominal aortic aneurysm (AAA) by ultrasonography. Provider bills CPT code 76770 with and ICD.10 code Z87.891. This would be considered a preventive service with no cost to the member.

2. Member is a 60 year old male with no previous history of smoking but with abdominal symptoms requiring an abdominal ultrasound. Provider bills CPT code 76775 and ICD.10 code R10.9 or R10.0. The procedure code billed is used for preventive services but the ICD.10 code is not and therefore based on the age of the member (or insured) and the diagnosis code, this would be considered a diagnostic procedure and subject to the member’s benefit plan.

3. Member is a 73 year old male with previous history of smoking and is scheduled for an abdominal aortic aneurysm (AAA) by ultrasonography. Provider bills CPT code 76770 with and ICD.10 code Z87.891. Member or insured, also scheduled for an ultrasound of the carotid arteries. Provider bills CPT code 93880 and ICD.10 code R55. No cost share would be taken on CPT code 76770 as this is considered a preventive service within the recommended preventive service criteria but cost share would be taken on CPT code 93880 as this is a non-preventive service.

Billing and Coding Guidelines

• Aetna will cover a one-time ultrasound screening for AAA for men 65 code 76770 – complete retroperitoneal ultrasound or CPT code 76775 – limited retroperitoneal ultrasound, as appropriate for the reporting of this service. Payment rates are not publicly available and will depend upon the contract each provider has negotiated with Aetna.

• Cigna will cover a one-time ultrasound screening for AAA for men age 65 - 75 who have ever smoked, male nonsmokers nearing age 65 with a family history of AAA, and female smokers age 70 or older with a family history of AAA. These coverage criteria only apply for those members who have coverage for preventive health services. Cigna’s policy also references the limited and complete retroperitoneal ultrasound codes. Payment rates are proprietary and variable as above.

• Several of the Blue Cross Blue Shield companies advise members determined by their physicians to be at risk for AAA to receive screening for AAA, but they note that this service may not be covered under all plans. In all instances, it is advisable for providers to contact the private insurance companies prior to providing the AAA screening to verify coverage
for their individual patients.

• A kidney can be evaluated as a part of a larger exam, or by itself. If it is part of a larger exam, use the CPT code 76770 - Ultrasound, retroperitoneal e.g. renal, aorta, nodes, real time with image documentation; complete. According to CPT a complete ultrasound examination of the retroperitoneum consists of B mode scans of kidneys, abdominal aorta, common iliac artery origins, and inferior vena cava, including any demonstrated retroperitoneal abnormality. Alternatively, if clinical history suggests urinary tract pathology, complete evaluation of the kidneys and urinary bladder also comprises a complete retroperitoneal ultrasound. Otherwise, a limited exam is reported with CPT code 76775. A limited study evaluates a single area or organ of interest.

CPT Code CPT Code Descriptor Global Payment Professional Payment Technical

Payment APC Code APC Payment 76770 Ultrasound, retroperitoneal (e.g., renal, aorta, nodes), real time with image documentation; complete. $132.39‡ $36.08 $96.31‡ 0266 $96.31

A complete ultrasound examination of the retroperitoneum (76770) consists of real time scans of the kidneys, abdominal aorta, common iliac artery origins, and inferior vena cava, including any demonstrated retroperitoneal abnormality.” Alternatively, if clinical history suggests urinary tract pathology, complete evaluation of the kidneys and urinary bladder also comprises a complete retroperitoneal ultrasound.

The documentation for diagnostic ultrasounds for a “complete” exam should contain a description of all required elements or explain as to why they could not be visualized. If the exam entails anything less than the above mentioned regions or does not explain why they could not be visualized, the corresponding limited ultrasound code would be reported. A “limited” study includes only a single quadrant or a single diagnostic issue.

This is why documentation is very important for these studies. If the documentation does not meet CPT guidelines for a retroperitoneal ultrasound (76770) by leaving out a comment on one or two of the required elements it means reporting 76775 for the limited. If billing globally this can be $20 less in reimbursement. A checklist may be one way to be sure all areas are covered for each ultrasound

SPINE AND PELVIS

(IV injection of contrast material is part of the CT procedure)

72010 Radiologic examination, spine, entire, survey study, anteroposterior and lateral

72020 Radiologic examination, spine, single view, specify level

72040 Radiologic examination, spine, cervical; 2 or 3 views

72050 4 or 5 views

72052 6 or more views

72069 Radiologic examination, spine, thoracolumbar, standing (scoliosis)

72070 Radiologic examination, spine; thoracic, two views

72072 thoracic, three views

72074 thoracic, minimum of four views

72080 thoracolumbar, two views

72090 scoliosis study, including supine and erect studies

72100 Radiologic examination, spine, lumbosacral; two or three views

72110 minimum of four views

72114 complete, including bending views, minimum of 6 views

72120 bending views only, 2 or 3 views

72125 Computed tomography, cervical spine; without contrast material

72126 with contrast material(s)

72127 without contrast material, followed by contrast material(s) and further sections

72128 Computed tomography, thoracic spine; without contrast material

72129 with contrast material(s)

72130 without contrast material, followed by contrast material(s) and further sections

72131 Computed tomography, lumbar spine; without contrast material

72132 with contrast material(s)

72133 without contrast material, followed by contrast material(s) and further sections

72141 Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast material

72142 with contrast material(s)

72146 Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; without contrast material

72147 with contrast material(s)

72148 Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material

72149 with contrast material(s)

72156 Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; cervical

72157 thoracic

72158 lumbar

72159 Magnetic resonance angiography, spinal canal and contents, with or without contrast material(s)

72170 Radiologic examination, pelvis; one or two views

72190 complete, minimum of three views

72191 Computed tomographic angiography, pelvis, with contrast material(s), including non-contrast images, if performed, and image postprocessing

72192 Computed tomography, pelvis; without contrast material

72193 with contrast material(s)

72194 without contrast material, followed by contrast material(s) and further sections

72195 Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s)

72196 with contrast material(s)

72197 without contrast material(s), followed by contrast material(s) and further sequences

72198 Magnetic resonance angiography, pelvis, with or without contrast material(s)

72200 Radiologic examination, sacroiliac joints; less than three views

72202 three or more views

72220 Radiologic examination, sacrum and coccyx, minimum of two views

72240 Myelography, cervical, radiological supervision and interpretation

72255 Myelography, thoracic, radiological supervision and interpretation

72265 Myelography, lumbosacral, radiological supervision and interpretation

72270 Myelography, two or more regions (eg, lumbar/thoracic, cervical/ thoracic, lumbar/cervical, lumbar/thoracic/cervical), radiological supervision and interpretation

72275 Epidurography, radiological supervision and interpretation

(72275 includes 77003)
(Use 72275 only when an epidurogram is performed, images documented and a formal radiologic report is issued)

72285 Discography, cervical or thoracic, radiological supervision and interpretation

72295 Discography, lumbar, radiological supervision and interpretation

CPT CODE and Description

71010 - Radiologic examination, chest; single view, frontal - Fee amount $20 - $26

71015 - Radiologic examination, chest; stereo, frontal

71020 - Radiologic examination, chest, 2 views, frontal and lateral; Fee amount $27 - $35

71021 - Radiologic examination, chest, 2 views, frontal and lateral; with apical lordotic procedure

71022 - Radiologic examination, chest, 2 views, frontal and lateral; with oblique projections

71023 - Radiologic examination, chest, 2 views, frontal and lateral; with fluoroscopy

71030 - Radiologic examination, chest, complete, minimum of 4 views; - Fee amount $35,- $45

71034 - Radiologic examination, chest, complete, minimum of 4 views; with fluoroscopy

71035 - Radiologic examination, chest, special views (eg, lateral decubitus, Bucky studies)

Indications and Limitations of Coverage and/or Medical Necessity

Note: Providers should seek information related to National Coverage Determinations (NCD) and other Centers for Medicare & Medicaid Services (CMS) instructions in CMS Manuals. This LCD only pertains to the contractor's discretionary coverage related to this service.

Radiologic examination of the chest (chest X-ray) facilitates the detection, diagnosis, staging and management of pathophysiologic processes involving thoracic, cardiovascular, pulmonary and mediastinal structures, contiguous coverings and the bony thorax. These examinations are covered by Medicare when medically necessary and appropriate for evaluation and management of a specific symptom, sign, disease or injury.

Chest X-rays are utilized in a variety of clinical states.

Generally accepted medical diagnoses are enunciated as Covered ICD-10 Codes (Covered Codes). Noridian Administrative Services will utilize these Covered Codes, and medical consultation, to assess medical necessity and appropriate utilization.

Routine, screening, pre operative or periodic examinations in the absence of symptoms, signs or disease states as represented by Covered ICD-10-CM Codes will not be reimbursed [Section 1862(a)(1)(A) of the Social Security Act].

Following a stable chronic condition, generally one examination in a twelve-month period will be considered appropriate. In acute or subacute conditions or when new symptoms or findings are documented, more frequent examinations will be considered for reimbursement and are subject to medical necessity review.

Submission with a Covered Code does not, a priori, equate with reimbursement. Clinical setting and examination frequency will also be assessed.

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

12 - Hospital Inpatient (Medicare Part B only)
13 - Hospital Outpatient
22 - Skilled Nursing - Inpatient (Medicare Part B only)
23 - Skilled Nursing - Outpatient
85 - Critical Access Hospital

Helpful Hints for Billing

The following example indicates the appropriate use of modifier 59 when two procedures codes that are not ordinarily performed together on the same day by the same provider, are reported.

• A single view chest x-ray (71010) is part of the more comprehensive radiologic exam described by 74022 (radiologic examination abdomen; complete acute abdomen series, including supine, erect, and/or decubitus views, single view chest). If these two procedures are reported together, 71010 will be denied separate reimbursement.

• When a single view chest x-ray is performed on the same day but at a different time and patient encounter, appending modifier 59 to CPT 71010 is warranted to signify that a separate and distinct service was performed. (Modifier 59 should follow modifier 26, if services are done in a facility setting.) Modifier 59 will override the procedure unbundling edit and 71010 will be eligible for separate reimbursement

** Always use Modifiers. For example for the CPT-4 code (chest-x-ray) 71010 use either modifier -26 or –TC to denote either the professional code or technical code.

** Pharmacy Providers may use Point of Sale

** Use website to view status of bill or authorization for services rendered: http//:owcp.dol.acs-inc.com

** Outpatient Hospital services can be billed on the UB 92 form with appropriate Revenue Center Codes requiring CPT/HCPCS codes.

** All bills must contain the DEEOIC’s 9-digit case number of your patient or client and your 9-digit provider number.

** Laboratory, x-ray, physical therapy, and clinical tests such as EKGs, etc. must be identified with the correct CPT code.

** Facility charges for ambulatory surgical center/outpatient surgery billing must be billed using the surgical CPT code. Modifier SG should be used.

** When billing for inpatient services, your Medicare number must be included.

*These procedures require pre-certification; call 1-877-PRE-AUTH

Physician Type CPT Codes Description

Primary Care Physicians: 71010-71030 Chest imaging
Cardiologists 71010-71030 Chest imaging
Pediatricians 71010-71030 Chest imaging
Pulmonologists 71010-71030 Chest Imaging

Reporting example:

For a single frontal chest x-ray, the claim for CPT code 71010 (Radiologic examination, chest; single view, frontal) would be submitted in one of the following two ways:

1. either as a global service, if the professional and technical components are submitted together:

** Global – 71010

2. or as individual claims for the professional and technical components, when submitted separately:

** Professional only – 71010-26 and

** Technical only – 71010-TC

Professional bilateral radiology services are reported as two lines with LT and RT modifiers

Radiology - Chest and rib X-ray

What is changing?

When CPT code 71010 and CPT code 71100 are billed for the same day, the codes will be recoded to the comprehensive CPT code or CPT code 71101.
** CPT code 71010 is defined as “radiologic examination, chest; single view, frontal.”
** CPT code 71100 is defined as ”radiologic examination, ribs, unilateral; two views.”
** CPT code 71101 is defined as “radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of three views.”

Why is Humana implementing this change?

CPT code 71010 is for a chest X-ray, and code 71100 is for rib views. If both views are being performed, the appropriate code to bill is code 71101, which is for the rib and chest views, per AMA’s CPT description.

AORTA AND ARTERIES

Selective vascular catheterizations should be coded to include introduction and all lesser order selective catheterizations used in the approach (eg, the description for a selective right middle cerebral artery catheterization includes the introduction and placement catheterization of the right common and internal carotid arteries).

Additional second and/or third order arterial catheterizations within the same family of arteries supplied by a single first order artery should be expressed by 36218 or 36248. Additional first order or higher catheterizations in vascular families supplied by a first order vessel different from a previously selected and coded family should be separately coded using the conventions described above.

75600 Aortography, thoracic, without serialography, radiological supervision and interpretation

75605 Aortography, thoracic, by serialography, radiological supervision and interpretation

75625 Aortography, abdominal, by serialography, radiological supervision and interpretation

75630 Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation

75635 Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast material(s),
including noncontrast images, if performed, and image postprocessing

75658 Angiography, brachial, retrograde, radiological supervision and interpretation

75705 Angiography, spinal, selective, radiological supervision and interpretation

75710 Angiography, extremity, unilateral, radiological supervision and interpretation

75716 Angiography, extremity, bilateral, radiological supervision and interpretation

75726 Angiography, visceral; selective or supraselective, (with or without flush aortogram), radiological supervision and interpretation

75731 Angiography, adrenal, unilateral, selective, radiological supervision and interpretation

75733 Angiography, adrenal, bilateral, selective, radiological supervision and interpretation

75736 Angiography, pelvic, selective or supraselective, radiological supervision and interpretation

75741 Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation

75743 Angiography, pulmonary, bilateral, selective, radiological supervision and interpretation

75746 Angiography, pulmonary, by nonselective catheter or venous injection, radiological supervision and interpretation

75756 Angiography, internal mammary, radiological supervision and interpretation

75774 Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation
(List separately in addition to primary procedure)

(Use 75774 in addition to code for specific initial vessel studied)

75791 Angiography, arteriovenous shunt (eg, dialysis patient fistula/graft), complete evaluation of dialysis access, including fluoroscopy, image documentation and report (includes injections of contrast and all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava), radiological supervision and interpretation

(Do not report 75791 in conjunction with 36147, 36148)

(Use 75791 only if radiological evaluation is performed through an already existing access into the shunt or from an access that is not a direct puncture of the shunt)

CPT CODE and description

73030 - Radiologic examination, shoulder; complete, minimum of 2 views - average fee amount - $25 - $30

73040 - Radiologic examination, shoulder, arthrography, radiological supervision and interpretation average fee amount - $90- $120

73020 - Radiologic examination, shoulder; 1 view

Non-interventional Diagnostic Imaging

Non-invasive/interventional diagnostic imaging includes but is not limited to standard radiographs, single or multiple views, contrast studies, computerized tomography and magnetic resonance imaging. The CPT Manual allows for various combinations of codes to address the number and type of radiographic views. For a given radiographic series, the procedure code that most
accurately describes what was performed should be reported. Because the number of views necessary to obtain medically useful information may vary, a complete review of CPT coding options for a given radiographic session is important to assure accurate coding with the most comprehensive code describing the services performed rather than billing multiple codes to describe the service.

1. If radiographs have to be repeated in the course of a radiographic encounter due to substandard quality, only one unit of service for the code can be reported. If the radiologist elects to obtain additional views after reviewing initial films in order to render an interpretation, the Medicare policy on the ordering of diagnostic tests must be followed. The CPT code describing the total service should be reported, even if the patient was released from the radiology suite and had to return
for additional services. The CPT descriptors for many of these services refer to a “minimum” number of views. If more than the minimum number specified is necessary and no other more specific CPT code is available, only that service should be reported. However, if additional films are necessary due to a change in the patient’s condition, separate reporting may be appropriate.

2. CPT code descriptors that specify a minimum number of views include additional views if there is no more comprehensive code specifically including the additional views. For example, if three views of the shoulder are obtained, CPT code 73030 (Radiologic examination, shoulder; complete, minimum of two views) with one unit of service should be reported rather than
CPT code 73020 (Radiologic examination, shoulder; one view) plus CPT code 73030.

LT, RT Modifier usage

Modifiers LT and RT are only considered valid for procedure codes specific to body parts that exist only twice in the body, once on the left and once on the right (paired body parts). For example, eye procedures (e.g. cataract surgery) and knee procedures (e.g. total knee replacement).
Modifiers LT and RT should be used when a procedure was performed on only one side of the body, to identify which one of the paired organs was operated upon.

LT and RT are not considered valid for toe procedures, excision of lesions, tendon/ligament injections (20550), or needle placements, etc. (Use finger and toe modifiers for finger and toe procedure codes; use eyelid modifiers for eyelid procedures.)

If the code description is for a structure that occurs multiple times on one side of the body (e.g. fingers, tendons, nerves, etc.) and is not specific enough for you to be able to mark on a body diagram where the left or right procedure is performed without looking at the medical record (e.g. place an “x” on the left shoulder for 73030-LT), then LT and RT are not valid modifiers.

(Modifier -59 may be needed to indicate a separate lesion, separate nerve, separate tendon, etc. for non-paired procedure codes.)

CPT CODE and description

76536 - Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), real time with image documentation - Average fee amount - $110 - $120

76604 - Ultrasound, chest (includes mediastinum), real time with image documentation

76641 - Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete average fee amount - $100 - $120

Coverage Indications, Limitations, and/or Medical Necessity

Ultrasound of the head and neck will be considered medically reasonable and necessary when used for the following indications:

· Evaluation of abnormalities in the tissues and/or organs of the head and neck (i.e., palpable masses)
· Evaluation of abnormalities detected on other imaging examinations (i.e., areas of abnormal uptake seen on radioisotope thyroid examinations)
· Personal or family history of thyroid malignancies
· Evaluation of suspected regional nodal metastases in patients with a proven thyroid carcinoma
· Follow-up of lesion/nodule (i.e., after medical suppression therapy)
· Localization of thyroid/parathyroid glands or cervical lymph nodes for biopsy, ablation, or other interventional procedures

Revenue Codes

CodeDescription
0320Radiology - Diagnostic - General Classification
0321Radiology - Diagnostic - Angiocardiography
0322Radiology - Diagnostic - Arthrography
0323Radiology - Diagnostic - Arteriography
0324Radiology - Diagnostic - Chest X-Ray
0329Radiology - Diagnostic - Other Radiology - Diagnostic

AACE appreciates the opportunity to comment on the Centers for Medicare and Medicaid Services (CMS) proposed rule and revisions to Medicare Part B payment policies under the Medicare Physician Fee Schedule (MPFS) for Calendar Year 2016, published in the Federal Register on July 15, 2015.

Our comments pertain to the following issues:

1. Identification of CPT™ Code 76536 as a Potentially Misvalued Code

2. Improved Payment for the Professional Work of Care Management Services

3. Establishing Separate Payment for Collaborative Care

4. CCM and TCM Services

5. Target for Relative Value Adjustments for Misvalued Services

6. Phase-In for Significant RVU Reductions

7. Clinical Improvement Activities under MIPS

8. Physician Compare

1. Identification of CPT Code 76536 as a Potentially Misvalued Code

Proposed Rule: CMS has included CPT™ code 76536, ultrasound exam of head and neck, in a list of potentially misvalued codes identified through the high expenditure by specialty screen.

CPT™ code 76536 was surveyed in April 2009 and proposed interim relative value units (RVUs) were included in the Medicare Physician Fee Schedule final rule for CY2010. CMS published final RVUs for CPT™ code 76536 in the 2011 Medicare Physician Fee Schedule final rule. AACE maintains that these actions constitute review of CPT™ code 76536 within the last five years and therefore CPT™ code 76536 does not fit the criteria for the misvalued code list and should be removed.

Payment Information

The following chart provides payment information that is based on the national unadjusted Medicare physician fee schedule for the ultrasound services discussed in this guide. Payment will vary by geographic region. Use the "Professional Payment" column to estimate reimbursement to the physician for services provided in facility settings.

Ambulatory Payment Classification (APC) codes and payments are used by Medicare to reimburse facilities under the Hospital Outpatient Prospective Payment System (OPPS). Payment is based on the national unadjusted OPPS amounts for facilities. The actual payment will vary by location.

CPT Code CPT Code Descriptor Global Payment Professional Payment Technical Payment APC Code APC Payment

76536 Ultrasound, soft tissues of head and neck (e.g. thyroid, parathyroid, parotid), real time with image documentation

$123.59

$28.66

$94.93

0266

$134.57

ICD CODE for CPT 76536

C47.0	Malignant neoplasm of peripheral nerves of head, face and neck
C49.0	Malignant neoplasm of connective and soft tissue of head, face and neck
C73	Malignant neoplasm of thyroid gland
C74.00	Malignant neoplasm of cortex of unspecified adrenal gland
C74.01	Malignant neoplasm of cortex of right adrenal gland
C74.02	Malignant neoplasm of cortex of left adrenal gland
C74.10	Malignant neoplasm of medulla of unspecified adrenal gland
C74.11	Malignant neoplasm of medulla of right adrenal gland
C74.12	Malignant neoplasm of medulla of left adrenal gland
C74.90	Malignant neoplasm of unspecified part of unspecified adrenal gland
C74.91	Malignant neoplasm of unspecified part of right adrenal gland
C74.92	Malignant neoplasm of unspecified part of left adrenal gland
C75.0	Malignant neoplasm of parathyroid gland
C75.4	Malignant neoplasm of carotid body
C76.0	Malignant neoplasm of head, face and neck
C77.0	Secondary and unspecified malignant neoplasm of lymph nodes of head, face and neck
C83.11	Mantle cell lymphoma, lymph nodes of head, face, and neck
C83.31	Diffuse large B-cell lymphoma, lymph nodes of head, face, and neck
C83.51	Lymphoblastic (diffuse) lymphoma, lymph nodes of head, face, and neck
C83.81	Other non-follicular lymphoma, lymph nodes of head, face, and neck
C84.41	Peripheral T-cell lymphoma, not classified, lymph nodes of head, face, and neck
C84.61	Anaplastic large cell lymphoma, ALK-positive, lymph nodes of head, face, and neck
C84.71	Anaplastic large cell lymphoma, ALK-negative, lymph nodes of head, face, and neck
C85.21	Mediastinal (thymic) large B-cell lymphoma, lymph nodes of head, face, and neck
D09.3	Carcinoma in situ of thyroid and other endocrine glands
D09.8	Carcinoma in situ of other specified sites
D21.0	Benign neoplasm of connective and other soft tissue of head, face and neck
D34	Benign neoplasm of thyroid gland
D35.1	Benign neoplasm of parathyroid gland
D49.7	Neoplasm of unspecified behavior of endocrine glands and other parts of nervous system
E01.0	Iodine-deficiency related diffuse (endemic) goiter
E01.1	Iodine-deficiency related multinodular (endemic) goiter
E01.2	Iodine-deficiency related (endemic) goiter, unspecified
E03.4	Atrophy of thyroid (acquired)
E04.0	Nontoxic diffuse goiter
E04.1	Nontoxic single thyroid nodule
E04.2	Nontoxic multinodular goiter
E04.8	Other specified nontoxic goiter
E04.9	Nontoxic goiter, unspecified
E05.00	Thyrotoxicosis with diffuse goiter without thyrotoxic crisis or storm
E05.01	Thyrotoxicosis with diffuse goiter with thyrotoxic crisis or storm
E05.10	Thyrotoxicosis with toxic single thyroid nodule without thyrotoxic crisis or storm
E05.11	Thyrotoxicosis with toxic single thyroid nodule with thyrotoxic crisis or storm
E05.20	Thyrotoxicosis with toxic multinodular goiter without thyrotoxic crisis or storm
E05.21	Thyrotoxicosis with toxic multinodular goiter with thyrotoxic crisis or storm
E05.30	Thyrotoxicosis from ectopic thyroid tissue without thyrotoxic crisis or storm
E05.31	Thyrotoxicosis from ectopic thyroid tissue with thyrotoxic crisis or storm
E05.40	Thyrotoxicosis factitia without thyrotoxic crisis or storm
E05.41	Thyrotoxicosis factitia with thyrotoxic crisis or storm
E05.80	Other thyrotoxicosis without thyrotoxic crisis or storm
E05.81	Other thyrotoxicosis with thyrotoxic crisis or storm
E05.90	Thyrotoxicosis, unspecified without thyrotoxic crisis or storm
E05.91	Thyrotoxicosis, unspecified with thyrotoxic crisis or storm
E06.0	Acute thyroiditis
E06.1	Subacute thyroiditis
E06.9	Thyroiditis, unspecified
E07.0	Hypersecretion of calcitonin
E07.1	Dyshormogenetic goiter
E07.89	Other specified disorders of thyroid
E07.9	Disorder of thyroid, unspecified
E21.4	Other specified disorders of parathyroid gland
E35	Disorders of endocrine glands in diseases classified elsewhere
K12.2	Cellulitis and abscess of mouth
L02.01	Cutaneous abscess of face
L02.11	Cutaneous abscess of neck
L03.211	Cellulitis of face
L03.212	Acute lymphangitis of face
L03.221	Cellulitis of neck
L03.222	Acute lymphangitis of neck
Q89.2	Congenital malformations of other endocrine glands
R22.0	Localized swelling, mass and lump, head
R22.1	Localized swelling, mass and lump, neck
R59.0	Localized enlarged lymph nodes
R59.1	Generalized enlarged lymph nodes
R59.9	Enlarged lymph nodes, unspecified
R90.0	Intracranial space-occupying lesion found on diagnostic imaging of central nervous system
R94.6	Abnormal results of thyroid function studies
Z85.850	Personal history of malignant neoplasm of thyroid
Z92.3	Personal history of irradiation

VEINS AND LYMPHATICS

75801 Lymphangiography, extremity only, unilateral, radiological supervision and interpretation

75803 Lymphangiography, extremity only, bilateral, radiological supervision and interpretation

75805 Lymphangiography, pelvic/abdominal, unilateral, radiological supervision and interpretation

75807 Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation

75809 Shuntogram for investigation of previously placed indwelling nonvascular shunt (eg, LeVeen shunt, ventriculoperitoneal shunt, indwelling infusion pump), radiological supervision and interpretation

75810 Splenoportography, radiological supervision and interpretation

75820 Venography, extremity, unilateral, radiological supervision and interpretation

75822 Venography, extremity, bilateral, radiological supervision and interpretation

75825 Venography, caval, inferior, with serialography, radiological supervision and interpretation

75827 Venography, caval, superior, with serialography, radiological supervision and interpretation

75831 Venography, renal, unilateral, selective, radiological supervision and interpretation

75833 Venography, renal, bilateral, selective, radiological supervision and interpretation

75840 Venography, adrenal, unilateral, selective, radiological supervision and interpretation

75842 Venography, adrenal, bilateral, selective, radiological supervision and interpretation

75860 Venography, venous sinus (eg, petrosal and inferior sagittal) or jugular, catheter, radiological supervision and interpretation

75870 Venography, superior sagittal sinus, radiological supervision and interpretation

75872 Venography, epidural, radiological supervision and interpretation

75880 Venography, orbital, radiological supervision and interpretation

75885 Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation

75887 Percutaneous transhepatic portography without hemodynamic evaluation, radiological supervision and interpretation

75889 Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation

75891 Hepatic venography, wedged or free, without hemodynamic evaluation, radiological supervision and interpretation

75893 Venous sampling through catheter, with or without angiography (eg, for parathyroid hormone, renin), radiological supervision and interpretation

CPT CODE and description

77002 - Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) average fee amount - $90 - $100

77003 - Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid) average fee amount - $80 - $100

Coding Guidelines

An imaging guidance code is billed only once per session for CPT code 77003, fluoroscopy or CPT code 77012 for CT guidance. Physicians may only bill for the professional component when imaging is performed in a hospital or non-office facility. No claim should be submitted for the hard or digital film(s) maintained to document needle placement.

The CPT code 72275 (Epidurography, radiological supervision and interpretation) differs from CPT code 77003 in that it represents a formal recorded and reported contrast study that includes fluoroscopy. Epidurography should only be reported when it is reasonable and medically necessary to perform a diagnostic study. Epidurography should not be billed when the contrast injection is part of the fluoroscopic guidance and contrast injection to confirm correct needle placement that is integral to the epidural, transforaminal and intrathecal injections addressed in the policy.

For example, CPT code 70332 describes radiological supervision and interpretation of a temporomandibular joint arthrogram. The CPT Manual instruction following CPT code 70332 states: “(Do not report 70332 in conjunction with 77002).” Therefore, CPT code 77002 (Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device)) is bundled into CPT code 70332.

Misuse of column two code with column one code - For example, CPT code 76930 describes imaging supervision and interpretation for ultrasound guidance for pericardiocentesis. CPT code 77002 describes fluoroscopic guidance for needle placement. Since imaging supervision and interpretation codes include all radiological services necessary to complete the service, it is a misuse of CPT code 77002 to report it separately with CPT code 76930. Therefore, CPT code 77002 is bundled into CPT code 76930.

General Policy Statements

Radiological supervision and interpretation codes include all radiological services necessary to complete the service. CPT codes for fluoroscopy/fluoroscopic guidance (e.g., 76000, 76001, 77002, 77003) or ultrasound/ultrasound guidance (e.g., 76942, 76998) should not be reported separately.

Radiological guidance procedures include all radiological services necessary to complete the procedure. CPT codes for fluoroscopy (e.g., 76000, 76001) should not be reported separately with a fluoroscopic guidance procedure. CPT codes for ultrasound (e.g., 76998) should not be reported separately with an ultrasound guidance procedure. A limited or localized followup computed tomography study (CPT code 76380) should not be reported separately with a computed tomography guidance procedure.

Radiology Modifier Example

Caudal epidural injection performed under fluoroscopic guidance fluoroscopic guidance

– Place of Service: physician office (POS 11)

62310 x 1 62310 x 1
77003 x 1 (guidance billed with no modifier)

– Place of service: Ambulatory Surgery Center (POS 24)
Place of service: Ambulatory Surgery Center (POS 24) Physician services billing:
62310 x 1 62310 x 1
77003 -26 x 1

 ASC facility billing: ASC facility billing:

62310 x 1
77003 –TC x 1 (separately billable will depend upon payer policy) (separately billable will depend upon payer policy

Joint Injection for Intra-articular Contrast Enhanced CT or MR

If fluoroscopic guidance is performed for a joint injection for intra-articular contrast enhanced CT or MR arthrography and no conventional radiographic arthrography procedure is performed, it is appropriate to separately report the fluoroscopic guidance code. The fluoroscopy used for an intra-articular injection for an enhanced CT or enhanced MR arthrography (typically a mixture of saline, marcaine and nonionic contrast media and/or gadolinium) involves additional physician work. This physician work is separate from the work included in the monitoring and interpretation of the contrast enhanced images included in the CT or MR “with contrast” procedures. For example, a CT with contrast arthrography (without anesthesia) study of the hip would be reported with 27093 for the injection, 77002 for the fluoroscopic guidance and 73701 for the CT with contrast arthrogram.

Note that when combined CT or MRI and conventional radiographic arthrography studies are performed, it would not be appropriate to report the fluoroscopic guidance code separately. As mentioned previously, the fluoroscopic guidance for needle placement is included in the arthrography RS&I code (70332, 73040, 73085, 73115, 73542, 73525, 73580, 73615). For example, a combined radiographic and CT with contrast arthrography of the knee would be reported with CPT® code 27370 for the injection, 73580 for the conventional radiographic arthrography, and 73701 for the CT arthrography. In this scenario, the RS&I code, 73580, includes fluoroscopy; therefore, code 77002 is not reported separately.

TRANSCATHETER PROCEDURES

75894 Transcatheter therapy, embolization, any method, radiological supervision and interpretation

75896 Transcatheter therapy, infusion, other than for thrombolysis, radiological supervision and interpretation

75898 Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion, other than for thrombolysis

75901 Mechanical removal of pericatheter obstructive material (eg, fibrin sheath) from central venous device via separate venous access, radiologic supervision and interpretation

75902 Mechanical removal of intraluminal (intracatheter) obstructive material from central venous device through device lumen, radiologic supervision and interpretation

75945 Intravascular ultrasound (non-coronary vessel), radiological supervision and interpretation; initial vessel

75946 each additional non-coronary vessel

(List separately in addition to primary procedure)

(Use 75946 in conjunction with 75945)

75952 Endovascular repair of infrarenal abdominal aortic aneurysm or dissection, radiological supervision and interpretation

75953 Placement of proximal or distal extension prosthesis for endovascular repair of infrarenal aortic or iliac artery aneurysm, pseudoaneurysm, or dissection, radiological supervision and interpretation

75954 Endovascular repair of iliac artery aneurysm, pseudoaneurysm, arteriovenous malformation, or trauma, using ilio-iliac tube
endoprosthesis, radiological supervision and interpretation (Report required)

75956 Endovascular repair of descending thoracic aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption); involving coverage of left subclavian artery origin, initial endoprosthesis plus descending thoracic aortic extension(s), if required, to level of celiac artery origin, radiological supervision and interpretation

75957 not involving coverage of left subclavian artery origin, initial endoprosthesis plus descending thoracic aortic extension(s), if required, to level of celiac artery origin, radiological supervision and interpretation

75958 Placement of proximal extension prosthesis for endovascular repair of descending thoracic aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption), radiological supervision and interpretation
(Report 75958 for each proximal extension)

75959 Placement of distal extension prosthesis(s) (delayed) after endovascular repair of descending thoracic aorta, as needed, to level of celiac origin, radiological supervision and interpretation

(Do not report 75959 in conjunction with 75956, 75957)

(Report 75959 once, regardless of number of modules deployed)

75962 Transluminal balloon angioplasty, peripheral artery other than renal, or other visceral artery, iliac or lower extremity, radiological supervision and interpretation

75964 Transluminal balloon angioplasty, each additional peripheral artery other than renal, or other visceral artery, iliac or lower extremity, radiological supervision and interpretation

(List separately in addition to primary procedure)

(Use 75964 in conjunction with 75962)

75966 Transluminal balloon angioplasty, renal or other visceral artery, radiological supervision and interpretation

75968 each additional visceral artery, radiological supervision and interpretation

(List separately in addition to primary procedure)

(Use 75968 in conjunction with 75966)

75970 Transcatheter biopsy, radiological supervision and interpretation

75978 Transluminal balloon angioplasty, venous (eg, subclavian stenosis), radiological supervision and interpretation

75980 Percutaneous transhepatic biliary drainage with contrast monitoring, radiological supervision and interpretation

75982 Percutaneous placement of drainage catheter for combined internal and external biliary drainage or of a drainage stent for internal biliary drainage in patients with an inoperable mechanical biliary obstruction, radiological supervision and interpretation

75984 Change of percutaneous tube or drainage catheter with contrast monitoring (eg, genitourinary system, abscess), radiological supervision and interpretation

75989 Radiological guidance (ie, fluoroscopy, ultrasound or computed tomography), for percutaneous drainage (eg, abscess or specimen collection), with placement of catheter, radiological supervision and interpretation

OTHER PROCEDURES

76000 Fluoroscopy (separate procedure), up to 1 hour physician or other qualified health care professional time, other than 71023 or 71034 (eg, cardiac fluoroscopy)

76001 Fluoroscopy, physician or other qualified health care professional time more than 1 hour, assisting a nonradiologic physician or other qualified health care professional (eg, nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy)

76010 Radiologic examination from nose to rectum for foreign body, single view, child

76080 Radiologic examination, abscess, fistula or sinus tract study, radiological supervision and interpretation

76098 Radiological examination, surgical specimen

76100 Radiological examination, single plane body section (eg, tomography), other than with urography

76101 Radiologic examination, complex motion (ie, hypercycloidal) body section (eg, mastoid polytomography), other than with urography; unilateral

76102 bilateral

76120 Cineradiography/videoradiography, except where specifically included

76125 Cineradiography/videoradiography, to complement routine examination

(List separately in addition to primary procedure)

76140 Consultation on X-ray examination made elsewhere, written report

76376 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; not requiring image postprocessing on an independent workstation

(Use 76376 in conjunction with code[s] for base imaging procedure[s])

(Do not report 76376 in conjunction with 70496, 70498, 70544-70549, 71275, 71555, 72159, 72191, 72198, 73206, 73225, 73706, 73725, 74175, 74175, 74185, 74261-74263, 75557, 75559, 75561, 75563, 75565, 75571-75574, 75635, 76377, 78012-78999, 0159T)
76377 requiring image postprocessing on an independent workstation

(Use 76377 in conjunction with code(s) for base imaging procedure[s])

(Do not report 76377 in conjunction with 70496, 70498, 70544-70549, 71275, 71555, 72159, 72191, 72198, 73206, 73225, 73706, 73725, 74174, 74175, 74185, 74261-74263, 75557, 75559, 75561, 75563, 75565, 75571-75574, 75635, 76376, 78012-78999, 0159T)

76380 Computed tomography, limited or localized follow-up study

76496 Unlisted fluoroscopic procedure (eg, diagnostic, interventional)

76497 Unlisted computed tomography procedure (eg, diagnostic, interventional)

76498 Unlisted magnetic resonance procedure (eg, diagnostic, interventional)

76499 Unlisted diagnostic radiographic procedure

S8032 Low-dose computer tomography for lung cancer screening

RADIOLOGIC GUIDANCE
FLUOROSCOPIC GUIDANCE

77001 Fluoroscopic guidance for central venous access device placement, replacement (catheter only or complete), or removal (includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic supervision and interpretation, and radiographic documentation of final catheter position) (List separately in addition to primary procedure) (Do not use 77001 in conjunction with 77002)

77002 Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device)

(77002 includes all radiographic arthrography with the exception of supervision and interpretation for CT and MR arthrography) (Do not report 77002 in addition to 70332, 73040, 73085, 73115, 73525, 73580, 73615)

(77002 is included in the organ/anatomic specific radiological supervision and interpretation procedures 49440, 74320, 74355, 74445, 74470, 74475, 75809, 75810, 75885, 75887, 75980, 75982, 75989)

77003 Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid) (Injection of contrast during fluoroscopic guidance and localization [77003] is included in 22526, 22527, 62263, 62264, 62267, 62270-62282, 62310-62319) (Do not report 77003 in conjunction with 64479-64484, 64490-64495)

MAGNETIC RESONANCE GUIDANCE

77021 Magnetic resonance guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation

77022 Magnetic resonance guidance for, and monitoring of, parenchymal tissue ablation

BREAST, MAMMOGRAPHY

77051 Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further review for interpretation, with or without digitization of film radiographic images; diagnostic mammography (List separately in addition to primary procedure)
(Use 77051 in conjunction with 77055, 77056)

77052 screening mammography (List separately in addition to primary procedure) (Use 77052 in conjunction with 77057)

77053 Mammary ductogram or galactogram, single duct, radiological supervision and interpretation

77054 Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation

77055 Mammography; unilateral

77056 bilateral

77057 Screening mammography, bilateral (2-view film study of each breast)

77058 Magnetic resonance imaging, breast, without and/or with contrast material(s); unilateral

77059 bilateral

G0202 Screening mammography, producing direct digital image, bilateral, all views

G0204 Diagnostic mammography, producing direct 2-d digital image, bilateral, all views

G0206 Diagnostic mammography, producing direct 2-d digital image, unilateral, all views

BONE/JOINT STUDIES

77071 Manual application of stress performed by physician or other qualified health care professional for joint radiography, including contralateral joint if indicated

77072 Bone age studies

77073 Bone length studies (orthoroentgenogram, scanogram)

77074 Radiologic examination, osseous survey; limited (eg, for metastases)

77075 complete (axial and appendicular skeleton)

77076 Radiologic examination, osseous survey, infant

77077 Joint survey, single view, 2 or more joints (specify)

77078 Computed tomography, bone mineral density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)

77080 Dual-energy x-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)

77081 appendicular skeleton (peripheral) (eg, radius, wrist, heel)

77084 Magnetic resonance (eg, proton) imaging, bone marrow blood supply

RADIATION ONCOLOGY

Listings for Radiation Oncology provide for teletherapy and brachytherapy to include initial consultation, clinical treatment planning, simulation, medical radiation physics, dosimetry, treatment devices, special services, and clinical treatment management procedures. They include normal follow-up care during course of treatment and for three months following its completion.

For treatment by injectable or ingestible isotopes, see subsection Nuclear Medicine.

CONSULTATION: CLINICAL MANAGEMENT

Preliminary consultation, evaluation of patient prior to decision to treat, or full medical care (in addition to treatment management) when provided by the therapeutic radiologist may be identified by the appropriate procedure codes from Evaluation and Management, Medicine or Surgery sections.

CLINICAL TREATMENT PLANNING (EXTERNAL AND INTERNAL SOURCES)

The clinical treatment planning process is a complex service including interpretation of special testing, tumor localization, treatment volume determination, treatment time/dosage determination, choice of treatment modality, determination of number and size of treatment ports, selection of appropriate treatment devices, and other procedures.

DEFINITIONS:

SIMPLE - planning requiring single treatment area of interest encompassed in a single port or simple parallel opposed ports with simple or no blocking.

INTERMEDIATE - planning requiring three or more converging ports, two separate treatment areas, multiple blocks, or special time dose constraints.

COMPLEX - planning requiring highly complex blocking, custom shielding blocks, tangential ports, special wedges or compensators, three or more separate treatment areas, rotational or special beam considerations, combination of therapeutic modalities.

Reimbursement for procedure codes 77261, 77262 & 77263 is for the global fee.

77261 Therapeutic radiology treatment planning; simple

77262 intermediate

77263 complex

DEFINITIONS:

SIMPLE - simulation of a single treatment area with either a single port or parallel opposed ports. Simple or no blocking.

INTERMEDIATE - simulation of three or more converging ports, two separate treatment areas, multiple blocks.

COMPLEX - simulation of tangential portals, three or more treatment areas, rotation or arc therapy, complex blocking, custom shielding
blocks, brachytherapy source verification, hyperthermia probe verification, any use of contrast materials.

Three-dimensional (3D) computer-generated 3D reconstruction of tumor volume and surrounding critical normal tissue structures from direct CT scans and/or MRI data in preparation for non-coplanar or coplanar therapy. The stimulation utilizes documented 3D beam’s eye view volume-dose displays of multiple or moving beams. Documentation with 3D volume reconstruction and dose distribution is required.

Simulation may be carried out on a dedicated simulator, a radiation therapy treatment unit, or diagnostic X-ray machine.

77280 Therapeutic radiology simulation-aided field setting; simple

77285 intermediate

77290 complex

77293 Respiratory motion management simulation (List separately in addition to code for primary procedure)

77299 Unlisted procedure, therapeutic radiology clinical treatment planning

NEUTRON BEAM TREATMENT DELIVERY

77422 High energy neutron radiation treatment delivery; single treatment area using a single port or parallel-opposed ports with no blocks or simple blocking (Report required)

77423 1 or more isocenter(s) with coplanar or non-coplanar geometry with blocking and/or wedge, and/or compensator(s) (Report required)

RADIATION TREATMENT MANAGEMENT

Radiation treatment management is reported in units of five fractions or treatment sessions, regardless of the actual time period in which the services are furnished. The services need not be furnished on consecutive days. Multiple fractions representing two or more treatment sessions furnished on the same day may be counted separately as long as there has been a distinct break in therapy sessions, and the fractions are of the character usually furnished on different days. Code 77427 is also reported if there are three or four fractions beyond a multiple of five at the end of a course of treatment; one or two fractions beyond a multiple of five at the end of a course of treatment are not reported separately. Procedure codes 77427-77469 are for the professional component only, no modifier required.

The professional services furnished during treatment management typically consists of:

• Review of port films;

• Review of dosimetry, dose delivery, and treatment parameters;

• Review of patient treatment set-up;

• Examination of patient for medical evaluation and management (eg, assessment of the patient’s response to treatment, coordination of care and treatment, review of imaging and/or lab results).

77427 Radiation treatment management, five treatments (Weekly clinical management is based on five fractions delivered comprising one week regardless of the time interval separating the delivery of treatments)

77431 Radiation therapy management with complete course of therapy consisting of one or two fractions only

(77431 is not to be used to fill in the last week of a long course of therapy)

77432 Stereotactic radiation treatment management of cranial lesion(s) (complete course of treatment consisting of one session)

77435 Stereotactic body radiation therapy, treatment management, per treatment course, to one or more lesions, including image guidance, entire course not to exceed 5 fractions (Do not report 77435 in conjunction with 77427-77432)

77469 Intraoperative radiation treatment management

77470 Special treatment procedure (eg, total body irradiation, hemibody radiation, per oral or endocavitary irradiation)

(77470 assumes that the procedure is performed 1or more times during the course of therapy, in addition to daily or weekly patient management)

77499 Unlisted procedure, therapeutic radiology treatment management

MEDICAL RADIATION PHYSICS, DOSIMETRY, TREATMENT DEVICES AND SPECIAL SERVICES

77295 3-dimensional radiotherapy plan, including dose-volume histograms

77300 Basic radiation dosimetry calculation, central axis depth dose, TDF, NSD, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of non-ionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician

77301 Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications

77306 Teletherapy isodose plan, simple (1 or 2 unmodified ports directed to a single area of interest), includes basic dosimetry calculation(s)

77307 complex (multiple treatment areas, tangential ports, the use of wedges, blocking, rotational beam, or special beam considerations), includes basic dosimetry calculation(s)

77316 Brachytherapy isodose plan; simple (calculation(s) made from 1 to 4 sources, or remote afterloading brachytherapy, 1 channel), includes basic dosimetry calculation(s)

77317 intermediate (calculation(s) made from 5 to 10 sources, or remote afterloading brachytherapy, 2-12 channel(s), includes basic dosimetry calculation(s)

77318 complex calculation(s) made from over 10 sources, or remote afterloading brachytherapy, over 12 channel(s), includes basic
dosimetry calculation(s)

77321 Special teletherapy port plan, particles, hemi-body, total body

77331 Special dosimetry (eg, TLD, microdosimetry) (specify), only when prescribed by the treating physician

77332 Treatment devices, design and construction; simple (simple block, simple bolus)

77333 intermediate (multiple blocks, stents, bite blocks, special bolus)

77334 complex (irregular blocks, special shields, compensators, wedges, molds or casts)

77336 Continuing medical radiation physics consultation, including assessment of treatment parameters, quality assurance of dose delivery, and review of patient treatment documentation in support of the radiation oncologist, reported per week of therapy (Reimbursement is for the global fee)

77338 Multi-leaf collimator MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per IMRT plan

(Do not report 77338 more than once per IMRT plan)

STEREOTACTIC RADIATION TREATMENT DELIVERY

77371 Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s) consisting of 1 session; multi-source Cobalt 60 based

77372 linear accelerator based

77373 Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions

OTHER PROCEDURES

77399 Unlisted procedure, medical radiation physics, dosimetry and treatment devices, and special services

procedure code and description

51798- Us urine capacity measure - average fee payment- $20 - $30

procedure code 51702 Insertion of temporary indwelling bladder catheter; simple (e.g., Foley)

• procedure code 51705 Change of cystostomy tube; simple

• procedure code 51798 Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging

Coverage Indications, Limitations, and/or Medical Necessity

Post-voiding residual (PVR) urine volume is the volume in the bladder immediately after the completion of voiding. The standard method of determining PVR urine volumes is intermittent catheterization, which is associated with increased risk of urinary infection, urethral trauma and discomfort for the patient. Bladder ultrasound has been introduced as an alternative, noninvasive method, to avoid the potential complications of intermittent catheterization.

The use of ultrasound to determine PVR is considered medically necessary and reimbursable for the following indications:

To assess urinary retention

To assess incomplete bladder emptying

To assist with bladder re-training by determining the need to void based on bladder volume

To determine actual bladder volume in patients who have incomplete bladder emptying and require frequent catheterizations to drain the bladder

PVR ultrasound is not considered to be medically necessary when performed for routine screening purposes or when no treatment is planned regardless of the finding.

Coding Information

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

Procedure /HCPCS Codes

51798Us urine capacity measure

ICD-10 Codes that Support Medical Necessity 51798

G83.4Cauda equina syndrome
N13.9Obstructive and reflux uropathy, unspecified
N23Unspecified renal colic
N31.0Uninhibited neuropathic bladder, not elsewhere classified
N31.1Reflex neuropathic bladder, not elsewhere classified
N31.2Flaccid neuropathic bladder, not elsewhere classified
N31.9Neuromuscular dysfunction of bladder, unspecified
N39.3Stress incontinence (female) (male)
N39.41Urge incontinence
N39.42Incontinence without sensory awareness
N39.43Post-void dribbling
N39.44Nocturnal enuresis
N39.45Continuous leakage
N39.46Mixed incontinence
N39.490Overflow incontinence
N39.491Coital incontinence
N39.492Postural (urinary) incontinence
N39.498Other specified urinary incontinence
N40.1Benign prostatic hyperplasia with lower urinary tract symptoms
R30.0Dysuria
R30.1Vesical tenesmus
R30.9Painful micturition, unspecified
R32Unspecified urinary incontinence
R33.0Drug induced retention of urine
R33.8Other retention of urine
R33.9Retention of urine, unspecified
R34Anuria and oliguria
R35.0Frequency of micturition
R35.1Nocturia
R35.8Other polyuria
R36.0Urethral discharge without blood
R36.9Urethral discharge, unspecified
R39.0Extravasation of urine
R39.11Hesitancy of micturition
R39.12Poor urinary stream
R39.13Splitting of urinary stream
R39.14Feeling of incomplete bladder emptying
R39.15Urgency of urination
R39.16Straining to void
R39.191Need to immediately re-void
R39.192Position dependent micturition
R39.198Other difficulties with micturition
R39.2Extrarenal uremia
R39.81Functional urinary incontinence
R39.82Chronic bladder pain
R39.89Other symptoms and signs involving the genitourinary system
R39.9Unspecified symptoms and signs involving the genitourinary system

CMS’ Final Decisions on the August 2012 Recommendations of the Hospital Outpatient Payment Panel on Supervision Levels for Select Services

In the Calendar Year (CY) 2012 Outpatient Prospective Payment System /Ambulatory Surgical Center (OPPS/ASC) Final Rule, the Centers for Medicare & Medicaid Services (CMS) established a process to obtain independent advice from the federal advisory Hospital Ou patient Payment Panel (the Panel) regarding the appropriate supervision levels for individual hospital outpatient therapeutic services (76 FR 74360). Accordingly, at its meeting on August 27-28, 2012 the Panel evaluated and made recommendations to CMS regarding 29 services. We then posted for public comment CMS’ preliminary decisions on the required supervision for these services, based on the Panel’s recommendations. Having considered the public comments that we received, following are our final decisions for the required supervision levels.

Effective January 1, 2013, 22 of the considered services may be furnished with a minimum of general supervision and the remaining 7 services will maintain their current designation as nonsurgical extended duration therapeutic services (extended duration services or NSEDTS*). A complete list of the services that may be furnished under general supervision or that are designated as NSEDTS is available on the CMS Website at http://www.cms.gov/Medicare/Medicare-Fee- orServicePayment/HospitalOutpatientPPS/index.html?redirect=/HospitalOutpatientPPS/01_overview.asp.

In particular, as we proposed the following services may be furnished under a minimum of general supervision.

• HCPCS code G0008 Administration of influenza virus vaccine

• HCPCS code G0009 Administration of pneumococcal vaccine

• HCPCS code G0010 Administration of hepatitis B vaccine

• HCPCS code G0127 Trimming of dystrophic nails, any number

• Procedure code 11719 Trimming of nondystrophic nails, any number

• Procedure code 36000 Introduction of needle or intracatheter, vein

• Procedure code 36591 Collection of blood specimen from a completely implantable venous access device

• Procedure code 36592 Collection of blood specimen using established central or peripheral catheter, venous, not otherwise specified

• Procedure code 51702 Insertion of temporary indwelling bladder catheter; simple (e.g., Foley)

• Procedure code 51705 Change of cystostomy tube; simple

• Procedure code 51798 Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging

• Procedure code 96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour

• Procedure code 96361 Intravenous infusion, hydration; each additional hour (list separately in addition to code for primary procedure)

• Procedure code 96521 Refilling and maintenance of portable pump

• Procedure code 96523 Irrigation of implanted venous access device for drug delivery systems

Pediatric and Neonatal Critical Care - Codes 36000, 36140, 36620, 36510, 36555, 36400, 36405, 36406, 36420, 36600, 31500, 94002, 94003, 94004, 94375, 94610, 94660, 94760, 94761, 94762, 36430, 36440, 43752, 51100, 51701, 51702 and 62270 are considered incidental to 99468, 99471 and 99475(Inpatient Neonatal and Pediatric Critical Care). The critical care procedure codes listed as a part of 99291 and 99292 are included in the Pediatric Neonatal Critical care and are considered incidental. Separate reimbursement is not allowed for incidental services

RADIATION TREATMENT DELIVERY

All treatment delivery codes are reported once per treatment session. The treatment delivery codes recognize technical-only services and contain no physician work (the professional component).

77401 Radiation treatment delivery, superficial and/or ortho voltage, per day

77402 Radiation treatment delivery, >1MeV; simple

77407 intermediate

77412 complex

77417 Therapeutic radiology port film(s)

77385 Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; simple

77386 complex

77387 Guidance for localization of target volume for delivery of radiation treatment delivery, includes intrafraction tracking, when performed

77424 Intraoperative radiation treatment delivery, x-ray, single treatment session

77425 Intraoperative radiation treatment delivery, electrons, single treatment session

HYPERTHERMIA

Hyperthermia treatments as listed in this section include external (superficial and deep), interstitial, and intracavitary. Radiation therapy when given concurrently is listed separately.

Hyperthermia is used only as an adjunct to radiation therapy or chemotherapy. It may be induced by a variety of sources, (eg, microwave, ultrasound, low energy radio- frequency conduction, or by probes).

The listed treatments include management during the course of therapy and follow-up care for three months after completion. Preliminary consultation is not included (see Evaluation and Management 99241-99255). Physics planning and interstitial insertion of temperature sensors, and use of external or interstitial heat generating sources are included.

The following descriptors are included in the treatment schedule:

77600 Hyperthermia, externally generated; superficial (ie, heating to a depth of 4 cm or less) (Report required)

77605 deep (ie, heating to depths greater than 4 cm) (Report required)

77610 Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators (Report required)

77615 more than 5 interstitial applicators (Report required)

CLINICAL INTRACAVITARY HYPERTHERMIA

77620 Hyperthermia generated by intracavitary probe(s) (Report required)

CLINICAL BRACHYTHERAPY

Clinical brachytherapy requires the use of either natural or man-made radioelements applied into or around a treatment field of interest. The supervision of radioelements and dose interpretation are performed solely by the therapeutic radiologist. When a procedure requires the service of a surgeon, see appropriate codes from the Surgery Section.

Services 77750-77799 include admission to the hospital and daily visits.

DEFINITIONS:

(Sources refer to intracavitary placement or permanent interstitial placement; ribbons refer to temporary interstitial placement.)

SIMPLE - application with one to four sources/ribbons

INTERMEDIATE - application with five to ten sources/ribbons

COMPLEX - application with greater than ten sources/ribbons

77750 Infusion or instillation of radioelement solution (includes three months follow-up care)

77761 Intracavitary radiation source application; simple

77762 intermediate

77763 complex

77776 Interstitial radiation source application; simple

77777 intermediate

77778 complex

77785 Remote afterloading high dose rate radionuclide brachytherapy; 1 channel

77786 2-12 channels

77787 over 12 channels

77789 Surface application of radiation source

77799 Unlisted procedure, clinical brachytherapy

procedure code and description

58340 - Catheterization and introduction of saline or contrast material for saline infusion sonohysterography (SIS) or hysterosalpingography (HSG) - average fee payment - $230 - $240

58345 Transcervical introduction of fallopian tube catheter for diagnosis and/or reestablishing patency (any method), with or without hysterosalpingography

58555 Hysteroscopy, diagnostic (separate procedure)

58559 Hysteroscopy, surgical; with lysis of intrauterine adhesions (any method

76831 Saline infusion sonohysterography (SIS), including color flow Doppler, when performed

BACKGROUND

Sonohysterography (also referred to as “hysterosonography”, “saline infusion sonohysterography” (SIH), and “saline-injected uterine ultrasound”), involves the injection of a fluid into the cervix and uterus just prior to ultrasound of these structures. In general, saline is the fluid used for this procedure, although the use of gel preparations is now under study. The injected fluid aids in the visual imaging of the reproductive anatomy. Sonohysterography is normally an outpatient procedure and takes approximately 15 minutes. (ACOG, 2012, 2011). Saline infusion sonohysterography (SIS) is a useful imaging modality prior to planned hysteroscopic or laparoscopic procedures for fibroids, polyps, and uterine anomalies to ensure safe and appropriate interventions (Singh, & et al., 2013). Substantial evidence exists to indicate that sonohysterography is superior to transvaginal ultrasonography in the detection of intracavitary lesions, such as polyps and submucosal leiomyomas (ACOG, 2012).

Contraindications

Sonohysterography should not be performed in a woman who is pregnant or who could be pregnant. This is usually avoided by scheduling the examination in the follicular phase of the menstrual cycle, after menstrual flow has essentially ceased but before the patient has ovulated. In a patient with regular cycles, sonohysterography should not in most cases be performed later than the 10th day of the menstrual cycle. Sonohysterography should not be performed in patients with a pelvic infection or unexplained pelvic tenderness, which could be due to pelvic inflammatory disease. Active vaginal bleeding is not a contraindication to the procedure but may make the
interpretation more challenging. (AIUM, 2011)

Limitations of Sonohysterography

Sonohysterography should typically not be performed in women with active pelvic inflammatory disease. In women with stenosis of the cervix, it may be somewhat difficult to insert the catheter into the cervical canal so that saline may be injected. Inadequate distension (expansion) of the uterine cavity from the saline injection may also prevent good-quality ultrasound images from being obtained. This can occur especially with uterine adhesions (scarring) or large benign tumors called fibroids, which may partially obliterate the uterine cavity. Also, sonohysterography is limited in the assessment of the patency, or openness, of the fallopian tubes because of their size and structure. In such cases where an abnormality of the fallopian tubes is suspected, a procedure such as hysterosalpingography might be recommended for further evaluation.

Saline sonohysterography for abnormal uterine bleeding is considered medically necessary for the following:

* Abnormal uterine bleeding; OR,

* Uterine cavity, especially with regard to uterine myomas, polyps, and synechiae; OR,

* Abnormalities detected on endovaginal sonography, including focal or diffuse endometrial or intracavitary abnormalities; OR,

* Congenital abnormalities of the uterus; OR,

* Recurrent pregnancy loss.

Exclusions and Contraindications

Saline sonohysterography for abnormal uterine bleeding is considered experimental and investigational for indications not listed above and therefore is not considered medically necessary. Further conclusions about the safety and effectiveness of this technology cannot be made until a full assessment has been completed. Abnormal uterine bleeding can be managed by other alternative options such as a dilatation and curettage (D&C), hysteroscopy with or without biopsy, or transvaginal ultrasound with or without endometrial biopsy or D&C.

Sonohysterography is contraindicated for women: 10

* Who are pregnant or who could be pregnant; OR,

* With a pelvic infection or unexplained pelvic tenderness (could be due to pelvic inflammatory disease)

Active vaginal bleeding is not a contraindication to the procedure however interpretation may be more challenging.

Covered Procedure Codes

58340 Catheterization and introduction of saline or contrast material for saline infusion sonohysterography (SIS) or hysterosalpingography

76831 Saline infusion sonohysterography (SIS), including color flow Doppler, when performed

Modifiers

In some cases, adding a modifier to the code may be necessary. Because Essure is considered a preventive service, add a modifier (33) to the procedure code (58565) and Essure Confirmation Test code (58340).

Procedure Modifier 33 is applicable for the identification of preventive services without cost sharing in 4 categories. Essure and the HSG fall under category 4: Preventive care and screenings provided for women (not included in the US Preventive Services Task Force A or B rating) in the comprehensive guidelines supported by the Health Resources and Services Administration.

Note: Not all commercial payers will require the use of Modifier 33. Some will automatically process the Essure procedure and the Essure Confirmation Test without patient cost sharing.

Rationale for Edit:

Anthem Central Region bundles 58555 as incidental with 58260. Following the CPT guidelines for Separate Procedures, this states:

“The codes designated as ‘separate procedure’ should not be reported in addition to the code for the total procedure or service of which it is considered an integral component.” Therefore, if 58555 is submitted with 58260—only 58260 reimburses

Anthem Central Region bundles 76830 as incidental with 76831, but 76830-59 does not bundle with 76831. Based on CPT Assistant, article Hysterosonography and Hysterosalpingography:

What's Included?

Code 76831 describes the imaging portion of the hysterosonography procedure. As indicated in the nomenclature of this code "with or without color flow Doppler is used during hysterosonography. Also, it would not be appropriate to separately report transvaginal ultrasound (76830) performed as an inherent part of the hysterosonogram. CPT code 76831 includes all ultrasound imaging performed during the hysterosonography procedure. However, if a transvaginal pelvic ultrasound is performed as a separate procedure prior to hysterosonography, this should be reported using code 76830 (echography, transvaginal). The modifier -59 should be appended in this instance.

Therefore, if 76830 is submitted with 76831--only 76831 reimburses, but if 76830-59 is submitted with 76831—both reimburse separately.

If on appeal, it documented that a separate transvaginal ultrasound (76830), is performed prior to the hysterosonography (76831), both may reimburse separately.

Covered ICD-9-CM Diagnosis Codes

626.8 Dysfunctional or functional uterine hemorrhage NOS
626.9 Dysfunctional or functional uterine hemorrhage unspecified
626.6 Metrorhagia
627.0 Premenopausal menorrhagia

Covered Draft ICD-10-CM Diagnosis Codes

N92.1 Excessive and frequent menstruation with irregular cycle
N89.7 Hematocolpos
N92.5 Other specified irregular menstruation
N93.8 Other specified abnormal uterine and vaginal bleeding
N92.6 Irregular menstruation, unspecified
N93.9 Abnormal uterine and vaginal bleeding, unspecified
N92.4 Excessive bleeding in the premenopausal period

procedure code and description

64635: Destruction by neurolytic agent, paravertebral facet joint nerve(s); (Fluoroscopy or CT); lumbar or sacral, single facet joint

64640: Destruction by neurolytic agent; other peripheral nerve or branch RF denervation in the sacroiliac region is commonly done at L5, S1, S2, and S3 levels. -average fee payment $140 - $150

64615 - Chemodenerv musc migraine - average fee payment - $160 - $170

Medical Review Required for Procedure Code 64615

Effective with dates of service beginning April 15, 2013, Medical Review is required for Current Procedural Terminology (Procedure ) code 64615 (Chemodenervation of muscle(s): innervated by facial…for chronic migraine) to determine if the following criteria have been met prior to allowing payment. For the treatment to be reimbursed using this code, documentation must be submitted with the claim that demonstrates that the patient meets these criteria related to chronic migraine:

• Fifteen or more days of headache or a headache that lasts 4 hours or more per day over 30 days

Please visit www.lamedicaid.com for the notice. If you have any questions please contact Molina Provider Relations at (800)473-2783 or (225)924-5040.

Effective January 1, 2013, physicians will be able to report the new Procedure code 64615 when performing chemodenervation to treat chronic migraine. Headache Medicine specialists have used OnabotulinumtoxinA “off-label” as an efficacious treatment for headache prophylaxis for a number of years. The October 15, 2010 FDA approval of Botox “…to prevent headaches in adult patients with chronic migraine” followed the pooled results from the double-blind, randomized, placebo-controlled Phase 3 Research Evaluating Migraine Prophylaxis Therapy (PREEMT) 1 and 2 trials (Headache 2010; 50:921-936). PREEMT demonstrated that OnabotulinumtoxinA was an effective prophyla tic treatment for chronic migraine. The PREEMT studies also defined the appropriate patient selection, injection sites, dosages and technique. It is likely that for reimbursement, insurers will monitor to document that the PREEMT protocol and injection paradigm targets were followed according to the published reports.

Basically every insurance plan does require pre-authorization. This usually includes the documentation of medical necessity. The diagnosis of “chronic migraine” must also be clearly defined in the physician’s medical records. The medication “J code” for Botox is J0585. The new Procedure administration code 64615 will need to be included. Usually carriers request the physician’s medical records to verify the documentation of diagnosis. Some insurance carriers also require a Botox Prior Authorization Form be completed and attached to the medical records. Authorization may take up to a few days to 10 days or longer.

Billing Guide for Procedure 64635, 64640

Physicians who currently perform RF denervation procedure in the sacroiliac region commonly use the following approach in coding:

RF lesion at L5/S1 facet joint: 64635

RF lesions at S1: 64640-59

RF lesions at S2: 64640-59

RF lesions at S3: 64640-59

Note: For bilateral procedures, use Modifier-50

According to the AMA, as published in the Procedure Assistant, December 2009:

“To differentiate between the work when performing sacral nerve destruction of S1, S2, S3, and S4, each individually separate peripheral nerve root neurolytic block is reported as destruction of a peripheral nerve, using code 64640, Destruction by neurolytic agent; other peripheral nerve or branch. In this instance, code 64640 is reported four times. It is suggested that Modifier 59, Distinct Procedural Service, be appended as well

When injection therapies for tarsal tunnel syndromes include "Baxter's injections" and/or injections for Morton’s neuroma use Procedure codes 64455 or 64632.

Revision: 10/01/2011, (Ten) allow on same DOS either Procedure code 64612 or 64613 for migraine. Added section titled “Either 64612 or 64613.” ICD-9 codes for Procedure procedures 64612 and 64613 are 346.70, 346.71, 346.72 and 346.73. Removed Procedure code 42699 and replaced with Procedure code 64611.Added for Procedure code 64611, ICD-9 codes 332.0 and 527.2. 03/01/2011, (Nine) added HCPCS code Q2040 effective 4/01/2011, removed J3490 effective 03/31/2011; 02/01/2011, (Eight), corrected typo in revision history, corrected HCPCS J0583 to HCPCS J0585, 01/01/2011, (Seven), per FDA approval of HCPCS code J0585 for this service added ICD-9 code 346.70 – 346.73, not covered for HCPCS code J0585 346.01 or 346.91;
12/01/2010, (Six) added information regarding Xeomin®, added ICD-9 code 346.01, 346.11, 346.91 w/Procedure code 64613 for J0585 dates of service after 10/15/10 ;

09/01/2010, (Five) added ICD-9 codes 596.54, 596.55 when billed with Procedure code 53899, 64614 or 64647 with an effective date of 05/16/2009;

02/01/2010, four, added Procedure code 53899, added ICD-9 596.59 and 788.41 with an effective date of 05/16/2009;

01/01/2010, three, annual HCPCS update change in description of Procedure code 95860, J0585, J0587, added J0586, removed reference to brand names in text of LCD;

10/01/2009 two, annual ICD-9, 2010 code update description change 784.40, 784.49 codes 784.42,784.43,784.44 added to range, added new codes 784.51,784.59 Deleted code 784.5;

07/01/2009, one, added ICD-9 code 374.03 and 333.1 to Procedure codes 64614 and 64640;

Note:

This information should be used in combination with LCD INJ-018 Treatment with Botulinum Toxin type A & type B.

For a Radiofrequency Treatment of the SI Joint, use code 64640.

The most common diagnosis codes for SI Joint Injection procedures are 724.6 for Disorders of the Sacrum and 720.2 for Sacroiliitis.

If an injection is administered in the Sacroiliac Joint without the use of Fluoroscopic guidance, report only the procedure code for the SI Joint Injection.

Total Laparoscopic Hysterectomy Procedure code

58570 Laparoscopy, surgical, with total hysterectomy, for uterus 250g or less $946

58571 Laparoscopy, surgical, with total hysterectomy, for uterus 250g or less, with removal of tube(s) and/or ovary(ies) $1,056

58572 Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250g 1,177

58573 Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250g, with removal of tube(s) and/or ovary(ies) 1,351

59400- Obstetrical care - average fee payment - $2370 - $2380

Obstetrical Billing Guidelines

Services included in the Global OB CPT®’ Code 59400 (Vaginal delivery) or 59510 (Cesarean delivery) Note:

• The following information is applicable to Plans with maternity benefits.

• Maternity care is subject to a one-time office visit copayment. For BCBS plans with a copayment, this copayment should be
collected at the time of the initial OB office visit.

• Physicians will be reimbursed for the initial OB visit separately from the “global maternity care” and should submit a claim for this service at the time of the initial OB visit. Claims should include expected delivery date.

All subsequent office visits for maternity care and delivery are considered as part of the “global maternity care” reimbursement.

Submit claim upon delivery

Amniocentesis Code amniocentesis separately from the global delivery code. Amniocentesis is not included in the Global CPT codes of 59400 (Vaginal delivery) or 59510 (Cesarean delivery).

Ultrasounds Code ultrasounds separately from the global delivery code. Ultrasounds are not included in the Global CPT codes of 59400 (Vaginal delivery) or 59510 (Cesarean delivery).

Where to Find More Information On Obstetrical Billing The answers to most obstetrical billing questions can be found in the “Physician’s Current Procedural Terminology (CPT)” manual. Maternity Care and Delivery is a subsection of the Surgery section. Surgical procedures are either package (global) services or starred procedures (non-global). An understanding of the global package services is needed to code Maternity Care and Delivery Services correctly. For additional resources on CPT coding, contact the American Medical Association (AMA) order desk at (800) 621-8335.

Global maternity care includes pregnancy-related antepartum care, admission to labor and delivery, management of labor including fetal monitoring, delivery, and uncomplicated postpartum care until six weeks postpartum.

A global charge should be billed for maternity claims when all maternity-related services, as outlined in Blue Cross and Blue Shield of North Carolina’s (BCBSNC’s) corporate medical policy “Guidelines for Global Maternity Reimbursement,” are provided by the same physician or physicians practicing at the same location. The number of antepartum visits may vary from patient to patient; however, if global maternity care (more than three antepartum visits, delivery and postpartum care) is provided, all maternity-related visits should be billed under the global maternity code. Individual E&M codes should not be billed to report maternity-related E&M visits. Prenatal care is considered an integral part of the global reimbursement and will not be paid separately

The Current Procedural Terminology® (CPT) manual identifies the following CPT codes as global maternity services:
+ 59400 - Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care

+ 59510 - Routine obstetric care including antepartum care, cesarean delivery and postpartum care

+ 59610 - Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care, after previous cesarean delivery

+ 59618 - Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, following attempted vaginal delivery after previous cesarean delivery

Billing tips:

+ An initial visit, confirming the pregnancy, is not a part of global maternity care services (verification of benefits will determine appropriate member liability).

+ A global charge should be billed when one or more physicians, practicing at the same location (filing under the same federal tax identification number), provide all components of the patient’s maternity care including; four or more antepartum visits, delivery and postpartum care. Note: Claims filed for partial maternity care with
E&M codes for one to three visits will deny when billed prior to the actual delivery, as all claims related to the maternity care must be received in order to account for the appropriate number of visits.

+ Antepartum services such as laboratory tests (excluding dipstick urinalysis), diagnostic ultrasound, amniocentesis, ordocentesis, chorionic villus sampling, fetal stress test, and fetal non-stress test are not considered part of global aternity services and should be billed separately.

Maternity billing codes

OB Global Billing:

59400 - Billed for vaginal delivery including ante-partum and postpartum. Do not use this code if less than 4 ante-partum visits performed. May have 22 or 52 modifier(s) appended.

59510 -Billed for c-section delivery including ante-partum and postpartum. Do not use this code if less than 4 ante-partum visits performed. May have 22, 52, AS, 80 modifier(s) appended.

59610 -Billed for VBAC delivery including ante-partum and postpartum. Do not use this code if less than 4 ante-partum visits performed. May have 22 or 52 modifier(s) appended.

59618 -Billed for c-section after attempted VBAC including ante-partum and postpartum. Do not use this code if less than 4 ante-partum visits performed. May have 22, 52, AS,80 modifier(s) appended.

CPT CODE 76770, 76775, 76776 - retroperitoneal ultrasound

SPINE AND PELVIS Radiology CPT codes

Chest X-RAY CPT CODES - 71010, 71020 - 71035

AORTA AND ARTERIES CPT CODE LIST

CPT CODE 73030, 73040 - Radiologic examination (x ray ) shoulder

CPT CODE 76536, 76604, 76641 - Ultrasound chest, breast , head and neck

VEINS AND LYMPHATICS CPT code list

CPT code 77002, 77003 - Fluoroscopic guidance

TRANSCATHETER PROCEDURES CPT code list

FLUOROSCOPIC GUIDANCE CPT CODE 77001 - 77003

BREAST, MAMMOGRAPHY BONE/JOINT STUDIES CPT codes

CPT code 77261, 77262 and 77263

CPT code 77422, 77423 NEUTRON BEAM TREATMENT DELIVERY

RADIATION PHYSICS, DOSIMETRY, TREATMENT DEVICES Procedure codes

Procedure code 51702, 51798, 51705

RADIATION TREATMENT DELIVERY and Hyperthermia Procedure codes

CLINICAL BRACHYTHERAPY PROCEDURE CODES 77750 - 77799

CPT CODE 58340, 58555, 76831 - Catheterization hysterosalpingography procedure

CPT code 64635, 64640, 64615 - Destruction neurolytic procedure

CPT code 59400, 58571, 58570, 58572, 58573 - Laparoscopy surgical