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Radiology Coding Alert

Coding Case Study:
Ace Renal Scan Coding: Avoid Double-Dipping

If your practice performs pre-ordered multiple kidney studies (one with pharmacological intervention and one without) on different days, you should report just one unit of CPT 78709 to avoid double-dipping. Be sure that the patient's chart demonstrates why you separated the two services and why they were medically necessary. It's one of the most complex aspects of radiology coding: The physician can't decide which tests will best benefit the patient until after he or she reads prior radiology reports. You can't report tests that the physician orders, however, if you don't perform them. Sheila Rosenfeld, MA, CNMT, FSNMTS, director of the nuclear medicine teleimaging network at St. Louis Veterans Administration Medical Center, offers the following example:

A patient presents to the nuclear medicine department for a renal scan to determine whether the patient has renal artery stenosis (440.1). Nuclear medicine performs the renal scan with pharmacological intervention but does not administer an ACE inhibitor because the patient is already on one. After finishing her report, the physician requests a baseline kidney imaging study. Nuclear medicine performs the baseline study one week after the original study. Which of the following coding scenarios is the best possible choice?

A. Report 78707 for the first study and another unit of 78707 for the second study. If the radiologist did not use pharmacological intervention for the first study or the second study, 78707 (Kidney imaging with vascular flow and function; single study without pharmacological intervention) would technically be the accurate choice for both studies. Because this code clearly indicates that the radiologist performed no pharmacological intervention, however, some coders feel that reporting it would be a misstatement of fact, as they view the ACE inhibitor as pharmacological intervention.

B. Report 78708 for the first study and 78707 for the second study. The National Correct Coding Initiative (NCCI) bundles 78707 into 78708 (Kidney imaging with vascular flow and function; single study, with pharmacological intervention [e.g., angiotensin converting enzyme inhibitor and/or diuretic]), but only if the radiologist performs both studies on the same day. Technically, these codes are both accurate if the radiologist uses pharmacological intervention during the first study.

C. Report 78709 once to describe all services included in the multi-day study. Because 78709 (Kidney imaging with vascular flow and function; multiple studies, with and without pharmacological intervention [e.g., angiotensin converting enzyme inhibitor and/or diuretic]) includes both the initial study and the subsequent baseline study, it describes both services performed, says Kay Tracy, BS, RCC, lead coder at the Oregon Clinic's radiology department. The Answer Depends on Physician Intent To determine which coding scenario is most accurate, the practice should determine the physician's intent, says Gary Dorfman, MD, FACR, SIR, president of Health Care Value Systems in North [...]


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