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Radiology Coding Alert

Radiopharmaceuticals Reimbursement Has Half a Life

Knowing when and how to report various HCPCS Level II or Level III codes is crucial if freestanding imaging centers and independent diagnostic testing facilities are to receive speedy and appropriate reimbursement for the medical supplies they provide.

Radiology coders in freestanding and independent facilities may often report medical supplies purchased, as long as carrier restrictions are met. "The only time a physician or radiology group should code and bill separately for contrast is when the professional entity bears the cost of purchasing the supplies," says Melody W. Mulaik, MSHS, CPC, RCC, president and co-founder of Coding Strategies Inc. in Atlanta. Therefore, the contrast may be considered a separately billable service when the radiology services are provided "with contrast."

But, outside of some A codes, there aren't that many codes that are still billable, says Craig McNabb, MBA, BSN, reimbursement manager for radiation for the Atlanta branch office of US Oncology, based in Houston. "This isn't a Happy New Year present, at all."

The Supplies for Radiologic Procedures section of HCPCS Codes contains a list of codes that freestanding and independent facilities may use. Four of the codes relate directly to contrast agents used during magnetic resonance imaging (A4643), computed tomography scans (A4644-A4646), as well as other diagnostic procedures that use iodinated contrast material:

A4643 Supply of additional high-dose contrast material(s) during magnetic resonance imaging, e.g., gadoteridol injection

A4644 Supply of low osmolar contrast material (100-199 mg of iodine)

A4645 Supply of low osmolar contrast material (200-299 mg of iodine)

A4646 Supply of low osmolar contrast material (300-399 mg of iodine)

A4647 Supply of paramagnetic contrast material (e.g., gadolinium).   When considering whether to report any of these supplies, coders must first look at who purchased them. Only the entity that bears the cost of purchasing supplies may bill for them, Mulaik says.

Radiologists who practice in a hospital setting, for instance, would not bill for these supplies, since the hospital would be the agent purchasing them. Freestanding centers, on the other hand, would buy the materials directly and therefore may report them along with any relevant procedural or supervision and interpretation codes. Of these, the codes for low osmolar contrast material (LOCM) are the most frequently used. According to CMS, LOCM has always been covered, regardless of diagnosis, Mulaik says, although hospitals have their reimbursement bundled into facility payments. She notes that CMS has further indicated that a beneficiary is not ever responsible for paying for any LOCM delivered in a HOPPS setting. Besides [...]

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