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Billing of Contrast

Amy Posted Fri 22nd of March, 2019 14:27:04 PM
If you have documentation that a CT with contrast was completed with intravenous administration of isovue. Dictation does not provide strength of isovue, is it appropriate to assign HCPCS Q9965 that contains the lowest strenth 100-199 mg/ml iodine concentration? Like wise if and MRI documents that it was completed as a with and without contrast, technique states "before and after contrast administration" is it appropriate to assign HCPCS A9579 since it's a not otherwise specified code?
SuperCoder Answered Mon 25th of March, 2019 08:41:56 AM

Hi Amy,

 

There are 4 different HCPCS codes that can be used for Isovue. The correct code should be used based on the iodine concentration in the product. 

 

  • Q9965 includes any LOCM with a concentration between 100–199 mg/ml iodine.
  • Q9966 includes any LOCM with a concentration between 200–299 mg/ml iodine. Use this code for Isovue‐200 and Isovue‐250
  • Q9967 includes any LOCM with a concentration between 300–399 mg/ml iodine. Use this code for Isovue‐300 and Isovue‐370.
  • Q9951 includes any LOCM with a concentration of 400 mg/ml iodine or more

 

Choose the appropriate HCPCS code as per your documentation. HCPCS code Q9965 cannot be considered as code of choice because the payment limit of this code is higher than the other mentioned codes. Hence it is requested to bill the code as per the concentration of the code mentioned in your documentation.

 

For your second question: If the contrast used is gadolinium-based magnetic resonance contrast agent, then HCPCS code A9579 is the only available code that can be used for gadolinium. There is no other option available and hence should be the code of choice.

 

Thanks!

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