Radiology Coding Alert

Zero In on New MRI Bundles Among the Slew of NCCI Edits


- Published on Wed, Jan 31, 2007
































And pay attention to the SPECT edits that didn’t change

With the massive radiology-related CPT changes for 2007, you probably guessed that the National Correct Coding Initiative (NCCI) edits released Jan. 1 would be overwhelming. But we’ve sorted through the 9,611 edits added by NCCI version 13.0, and here’s what you need to know.

A large proportion of the new edits account for the guidance, mammography, and other 2007 radiology code changes that gave many codes new digits without changing their descriptors

Example: In 2006 you had to abide by this column 1-column 2 (non-mutually exclusive) edit:

Column 1                                              Column 2                                                  Modifier Indicator

76091 (Mammography; bilateral)               76090 (… unilateral)                                    0

In 2007, under 13.0, you have this column 1-column 2 edit, which reflects the change in the digits for these mammogram codes:

Column 1                                            Column 2                                                    Modifier Indicator

77056 (Mammography; bilateral)             77055 (… unilateral)                                      0

Remember: With column 1-column 2 edits, you should report the column 1 code, not the column 2 code. If you report them both, payers will only reimburse you for the column 1 code. The “0” modifier indicator means that you cannot use a modifier to break the edit.

Watch for: NCCI also adds a tremendous number of edits for intraoperative ultrasound, says Jackie Miller, RHIA, CPC, senior coding consultant for Coding Strategies Inc. in Powder Springs, Ga. Code 76986 described this service in 2006, but in 2007 you use 76998 (Ultrasonic guidance, intraoperative).

Don’t Assume Functional MRI Is Always in Column 2

Version 13.0 also adds edits for 2007’s new functional brain MRI codes. Along with the usual edits bundling in anesthesia and guidance, “the new edits bundle MRI (codes 70554-70555) into MRI of the brain with contrast (70552) and with and without contrast (70553),” Miller says.

“MRI of the brain without contrast (70551) is bundled into MRI without physician testing (70554), but MRI withphysician testing (70555) is bundled into 70551,” she adds.

Each of the edits has a modifier indicator of “1,” which means you may use a modifier to override the edit. 
 
Example: CPT guidelines tell you not to report functional brain MRI codes 70554-70555 with brain MRI codes 70551-70553 unless you perform a separate diagnostic MRI.

Pay attention: While functional brain MRIs typically fall in column 2, be sure you note that NCCI bundles a brain MRI without contrast, 70551, into a functional brain MRI that doesn’t require physician or psychologist administration, 70554.

Code 96020 note: The edits also help you abide by the CPT instruction not to report 96020 with 70554. You should only report 70555 when 96020 is performed.

Check With Payer Before Breaking SPECT Edit

Despite speculation that you might see changes to SPECT/first pass imaging edits, NCCI 13.0 keeps those edits the same.

The details: NCCI edits released in [...]

Radiology Coding Alert
Issue - Jan, 2007
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