Resource Compliance Questions of the Week

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A weekly email update that answers difficult trending billing and coding questions in Radiology, Cardiology, Pharmacy, Laboratory and other specialties.

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SEPTEMBER 14, 2020


CARDIOLOGY

Question:
May we report code 0482T (absolute quantification) along with the new cardiac positron emission tomography (PET) codes in 2020?
READ THE ANSWER

LABORATORY

Question:
Can we perform repeat organ and disease-oriented panel procedures on a single day of service?
READ THE ANSWER

PHARMACY

Question:
Can we use hydration codes to report drug infusion?
READ THE ANSWER

RADIOLOGY

Question:
What are the anticipated changes to percutaneous core needle lung biopsy?
READ THE ANSWER

RESPIRATORY

Question:
Do you have any advice for billing oximetry trend studies?
READ THE ANSWER

GENERAL

Question:
A progress note from our nurse practitioner (NP) indicated that she was called by nursing to see a patient due to “unequal pupils.” The NP ordered a CT/CTA to rule out associated dissection or blood clot post angiogram earlier today. Would it be correct to assign a diagnosis code for unequal pupils as primary?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF DECEMBER 7, 2020​

CARDIOLOGY​

​

Question:
We perform cardiac PET scanning at our facility. After cardiologists read the initial exam, the CT images are stripped and sent to a radiologist to read and he generates an additional report. We do not have a charge for the CT radiologist’s component. Is there a CPT® that would allow that?
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LABORATORY​

​

Question:
Do you have any tips for overutilization monitoring?
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PHARMACY​

​

Question:
Are routine fluids administered over the course of chemotherapy to maintain line patency prior to drugs separately reportable as hydration therapy?
READ THE ANSWER

RADIOLOGY​

​

Question:
What is the code for an ultrasound of the prostate?
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RESPIRATORY​

​

Question:
Is there a CPT® code for oxygen?
READ THE ANSWER

GENERAL​

​

Question:
Does the modified barium swallow code 74230 include scout films?
READ THE ANSWER

 

[WhitneyH_24046]

Thanks!

 

[Lori]

FOR THE WEEK OF DECEMBER 21, 2020​

CARDIOLOGY​

​

Question:
Can we report 33222 with complex repair codes from the Integumentary System?
READ THE ANSWER

LABORATORY​

​

Question:
Are there P-codes that account for an autologous or a directed donor unit?
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PHARMACY​

​

Question:
What system are drugs furnished to hospital outpatients paid under?
READ THE ANSWER

RADIOLOGY​

​

Question:
Is the type of contrast and amount administered required to be documented within the radiology report?
READ THE ANSWER

RESPIRATORY​

​

Question:
What HCPCS codes describe respiratory therapy rehabilitation services?
READ THE ANSWER

GENERAL​

​

Question:
What must be included in the report to determine the difference between fetal biophysical profile codes 76818 and 76819?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF JANUARY 4, 2021​

CARDIOLOGY​

Question:
Can we map the coronary sinus by contrast injection with either codes 33225 or 33224?
READ THE ANSWER​

LABORATORY​

Question:
Are there any new codes for chemistry?
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PHARMACY​

Question:
Can we report 96413, 96415, or 96417 for protectant drugs or rescue therapies?
READ THE ANSWER​

RADIOLOGY​

Question:
Can you tell me more about new ablation code 55880?
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RESPIRATORY​

Question:
If we are using the forced expiratory volume (FEV1) from the spirogram to calculate an estimated MVV can we report code 94200?
READ THE ANSWER​

GENERAL​

Question:
One of our breast-center doctors does not specify tomosynthesis in the technique section of mammograms, but tomosynthesis views are mentioned in the body of the report. Does she have to dictate them in the technique or will it be enough that it is mentioned in the body?
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[Lori]

FOR THE WEEK OF JANUARY 11, 2021​

CARDIOLOGY​

​

Question:
Can we separately report selective vascular catheterization codes when performed with an EP study?
READ THE ANSWER

LABORATORY​

​

Question:
Regarding blood products, can we bill if the autologous unit was unused and subsequently destroyed?
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PHARMACY​

​

Question:
Do erythropoiesis-stimulating agents (ESAs) qualify as highly complex drugs?
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RADIOLOGY​

​

Question:
Do you have any tips on new biopsy code 32408?
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RESPIRATORY​

​

Question:
What is the new code for the exercise test for bronchospasm?
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GENERAL​

​

Question:
I am trying to find a diagnosis code for chronic anterior cruciate ligament tear of the right knee. The clinical history is knee pain, evaluate meniscus and cartilage with history of recurrent patella subluxation. If I go to tear ligament it directs you to sprain. Sprain cruciate ligament, anterior is S83.511, which doesn’t seem right because this isn’t a current tear. Any suggestions?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF JANUARY 18, 2021​

CARDIOLOGY​

Question:
Can we bill for an angiogram and catheter placement for a failed access site done during a Left Heart Catheterization (LHC)? For example, the right radial artery (RRA) access was obtained but we could not navigate the wire to the right subclavian. Right brachial artery angiography was performed through the diagnostic catheter. There was moderate tortuosity and the vessel size was small, and a decision was made to pursue a right femoral artery access. Could we bill 36140-59 and 75710-59 with LHC 93458?
READ THE ANSWER​

LABORATORY​

Question:
Can codes like 87088 and 87184 be used multiple times in association with 87086?
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PHARMACY​

Question:
Are injectable drugs such as intravenously administered drugs normally eligible for inclusion under the “incident to” benefit?
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RADIOLOGY​

Question:
Does the JW modifier policy apply to radiopharmaceutical waste?
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RESPIRATORY​

Question:
Can you tell me more about flexibilities regarding direct supervision requirement during the public health emergency?
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GENERAL​

Question:
What is the appropriate ICD-10-CM for retrolisthesis of C5 relative to C6? There is nothing in ICD-10 under “retrolisthesis” and I wasn’t sure if you go to “displacement” intervertebral disc, cervical M50.222? Or is there another term to look under for retrolisthesis. Does the doctor need to change how he documents this problem?
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[Lori]

FOR THE WEEK OF JANUARY 25, 2021​

CARDIOLOGY​

​

Question:
Do you have any tips for new code 33741?
READ THE ANSWER

LABORATORY​

​

Question:
What is the update to the local clinical laboratory fee?
READ THE ANSWER

PHARMACY​

​

Question:
Do you have any tips on revenue code 636?
READ THE ANSWER

RADIOLOGY​

​

Question:
A CT of the head without contrast is performed in the morning, and a CT of the head with contrast is performed on the same day in the afternoon. Is it correct to code this scenario using 70450 with 70460 separately accompanied by modifier 59, or choose just 70470?
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RESPIRATORY​

​

Question:
What is the APC status indicator for 94016?
READ THE ANSWER

GENERAL​

​

Question:
I am trying to find a diagnosis code for chronic anterior cruciate ligament tear of the right knee. The clinical history is knee pain, evaluate meniscus and cartilage with history of recurrent patella subluxation. If I go to tear ligament it directs you to sprain. Sprain cruciate ligament, anterior is S83.511, which doesn’t seem right because this isn’t a current tear. Any suggestions?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF FEBRUARY 1, 2021​

CARDIOLOGY​

​

Question:
Do you have any advice on code 92941/C9606?
READ THE ANSWER

LABORATORY​

​

Question:
What is the update to the national minimum payment amount?
READ THE ANSWER

PHARMACY​

​

Question:
I know that drugs normally billed as chemotherapy administration will be associated primarily with a code found in the J9XXX series, are there any exceptions?
READ THE ANSWER

RADIOLOGY​

​

Question:
I heard that the ACR and others helped to lessen the anticipated Medicare cuts finalized in the Medicare Physician Fee Schedule, can you tell me more?
READ THE ANSWER

RESPIRATORY​

​

Question:
What is the reimbursement rate for 99406 and 99407 for 2021?
READ THE ANSWER

GENERAL​

​

Question:
What are the documentation requirements to bill for hydration?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF FEBRUARY 8, 2021​

CARDIOLOGY​

​

Question:
If a coronary angioplasty (PTCA) is done, then a drug-eluting stent (DES) is attempted, but unable to cross lesion do you code this as C9600-74?
READ THE ANSWER

LABORATORY​

​

Question:
What is the consumer price index for 2021?
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PHARMACY​

​

Question:
What is the difference between white bagging and brown bagging regarding patient supplied drugs?
READ THE ANSWER

RADIOLOGY​

​

Question:
What is the appropriate code for a percutaneous biopsy of the lung?
READ THE ANSWER

RESPIRATORY​

​

Question:
Is the NCD 210.4 still active for smoking and tobacco use cessation counseling?
READ THE ANSWER

GENERAL​

​

Question:
What is the difference between oral hydration and intravenous hydration therapy?
READ THE ANSWER

 

[WhitneyH_24046]

Thanks for sharing these Lori!

 

[Lori]

FOR THE WEEK OF FEBRUARY 15, 2021​

CARDIOLOGY​

​

Question:
Please explain the difference between single study myocardial perfusion SPECT (78451) and multiple studies SPECT (78452).
READ THE ANSWER

LABORATORY​

​

Question:
What is the revenue code for albumin products and which codes should I report for an infusion?
READ THE ANSWER

PHARMACY​

​

Question:
We have a patient who received three hours of IV hydration. During that time, the patient received two different drugs by intravenous push. Can the entire three hours of IV hydration be coded with the intravenous push injections?
READ THE ANSWER

RADIOLOGY​

​

Question:
Please clarify whether a screening mammogram or a diagnostic mammogram should be performed on an asymptomatic patient with augmented breasts (e.g., breast implants).
READ THE ANSWER

RESPIRATORY​

​

Question:
Is there a CPT code and billing instruction that represents the collection of specimens via nasal lavage and suction for RSV?
READ THE ANSWER

GENERAL​

​

Question:
We have a question regarding the requirement, if any, for the technique in an MRI report. Sometimes we don’t get any technique, but here are some examples of what we are getting: “TECHNIQUE: MRI of the right knee was performed before and after the uneventful intravenous administration of 12/17 mL ProHance.” “TECHNIQUE: MR images were obtained of the left hip without intravenous or intra-articular contrast.” Should we be insisting on a description of the images that were obtained?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF FEBRUARY 22, 2021​

CARDIOLOGY​

​

Question:
Can code 93565 be reported for diagnostic selective left atrial with Category III codes?
READ THE ANSWER

LABORATORY​

​

Question:
What is the purpose of COVID codes 87636 and 87637?
READ THE ANSWER

PHARMACY​

​

Question:
Can you charge an XS modifier with IVP drug administration codes?
READ THE ANSWER

RADIOLOGY​

​

Question:
Please clarify whether a screening mammogram or a diagnostic mammogram should be performed on an asymptomatic patient with augmented breasts (e.g., breast implants).
READ THE ANSWER

RESPIRATORY​

​

Question:
We are confused about some of the details surrounding 94060. Do you know what the NCCI says about components for this code?
READ THE ANSWER

GENERAL​

​

Question:
Can you tell me more about the background basics of NCCI edits?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF MARCH 1, 2021​

CARDIOLOGY​

​

Question:
When an EKG is ordered and read during the office visit, does that count as two points for the new Evaluation and Management (E/M) coding?
READ THE ANSWER

LABORATORY​

​

Question:
If we have multiple markers for reporting flow cytometry tests using code 88184, how would this process work for coding?
READ THE ANSWER

PHARMACY​

​

Question:
What is the correct way to report two drugs that are administered at the same time through two separate IV lines?
READ THE ANSWER

RADIOLOGY​

​

Question:
Can we report 78445 with any other nuclear medicine procedures?
READ THE ANSWER

RESPIRATORY​

​

Question:
Can we bill for both 95782 and 95873 when reporting a sleep study?
READ THE ANSWER

GENERAL​

​

Question:
Can you explain the differences between PTP, MUE, and AOC edits mentioned in last week’s question?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF MARCH 8, 2021​

CARDIOLOGY​

​

Question:
Can we bill for an angiogram and catheter placement for a failed access site done during a Left Heart Catheterization (LHC)? For example, the right radial artery (RRA) access was obtained but we could not navigate the wire to the right subclavian. Right brachial artery angiography was performed through the diagnostic catheter. There was moderate tortuosity and the vessel size was small, and a decision was made to pursue a right femoral artery access. Could we bill 36140-59 and 75710-59 with LHC 93458?
READ THE ANSWER

LABORATORY​

​

Question:
Are there any PLA codes in immunology for COVID-19?
READ THE ANSWER

PHARMACY​

​

Question:
How would we bill the concurrent IV administration of one chemotherapy drug and one non-chemotherapy when the drugs are given with separate bags at the same site?
READ THE ANSWER

RADIOLOGY​

​

Question:
Can you please recommend an appropriate code for an ultrasound of soft tissue mass upper back?
READ THE ANSWER

RESPIRATORY​

​

Question:
What is the difference in intent with codes 95812 and 98513?
READ THE ANSWER

GENERAL​

​

Question:
For ultrasound exams that are non-diagnostic due to gas, body habitus, etc. is it appropriate to down code to a limited exam (if ordered as complete) and append a modifier 52?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF MARCH 15, 2021​

CARDIOLOGY​

​

Question:
What diagnosis code(s) should we use for an echocardiogram performed with contrast?
READ THE ANSWER

LABORATORY​

​

Question:
Can we use flow cytometry series of codes to bill for absolute cell counts for those not requiring interpretation if they are performed by flow cytometry?
READ THE ANSWER

PHARMACY​

​

Question:
Can you tell us if codes 96365 and 96368 are appropriate for the following scenario? The patient is seen in the outpatient clinic for drug infusion. Drug A is administered from 6:00 am to 7:30 am. Drug B is administered through the same intravenous line from 7:00 am to 4:00 pm.
READ THE ANSWER

RADIOLOGY​

​

Question:
Should there be an additional charge for MR Elastography (MRE) when performed with MRI of the abdomen? If so, should we use the unlisted code 76948?
READ THE ANSWER

RESPIRATORY​

​

Question:
Is code 54250 payable when billed with PSGs codes?
READ THE ANSWER

GENERAL​

​

Question:
Is there somewhere a list of typical “minor” procedures is documented? And am I correct that Medicare states the attending physician must be present for the entire procedure for minor procedures?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF MARCH 22, 2021​

CARDIOLOGY​

​

Question:
If a tracing is performed when the physician does not own the equipment or employ the personnel while providing just the interpretation, what code is assigned for the professional service?
READ THE ANSWER

LABORATORY​

​

Question:
What are the revenue codes for 86XXX and 87XXX series?
READ THE ANSWER

PHARMACY​

​

Question:
If an infusion is stopped because the patient is having an adverse
reaction to a drug, can we still charge for the infusion?
READ THE ANSWER

RADIOLOGY​

​

Question:
What code should be used for a computed tomography (CT)-guided breast wire localization?
READ THE ANSWER

RESPIRATORY​

​

Question:
What codes should be reported for testing that diagnoses exercise induced bronchoplasm?
READ THE ANSWER

GENERAL​

​

Question:
Did Medicare ever fix the NCCI edit for A9570 with 78802?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF MARCH 29, 2021​

CARDIOLOGY​

​

Question:
If the hospital receives outside images (consult) of the CTA and derives the FFR from that CTA, can the hospital bill for the FFR service?
READ THE ANSWER

LABORATORY​

​

Question:
Can we use the TC modifier with 88291?
READ THE ANSWER

PHARMACY​

​

Question:
We placed a patient in observation and the next day the physician admitted him as an inpatient. Can we code for drug administration services for the time the patient was in observation status?
READ THE ANSWER

RADIOLOGY​

​

Question:
Does a reconstructed spine need to be ordered?
READ THE ANSWER

RESPIRATORY​

​

Question:
We are getting denials when reporting 94640, can you please clarify what the code accounts for?
READ THE ANSWER

GENERAL​

​

Question:
For billing chemotherapy infusions, what determines the selection of the primary code?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF APRIL 5, 2021​

CARDIOLOGY​

​

Question:
Should the date of service (DOS) of the FFR derived from a CTA be the same as the DOS of the coronary CTA?
READ THE ANSWER

LABORATORY​

​

Question:
Can you tell me more about when the Z-code is not required?
READ THE ANSWER

PHARMACY​

​

Question:
When can discarded drugs be paid by Medicare?
READ THE ANSWER

RADIOLOGY​

​

Question:
Is there a difference between the peripheral segment start and end points if the patient has an AV -Shunt in the arm or the leg?
READ THE ANSWER

RESPIRATORY​

​

Question:
What are the minimum requirements for a face-to-face clinical evaluation for polysomnography?
READ THE ANSWER

GENERAL​

​

Question:
For CT exams, do you know if we have to specify the type and volume of contrast for billing, or is it just the statement that iodinate contrast was administered enough? I was unable to find any type of reference source as it should be documented or stating iodinate contrast is enough. Could you direct me to some type of reference source to share with my providers?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF APRIL 12, 2021​

CARDIOLOGY​

​

Question:
In the example of the EKG with an EP study, do you agree that we should report the 93005 but not modify it with modifier 59? Do other hospitals override the edit instead of using the GZ? If the entire claim is denied due to the GZ modifier being on the claim, what action should we take? Should we reach out to our FI?
READ THE ANSWER

LABORATORY​

​

Question:
Can modifier 91 be appended to every laboratory code that is reported more than one time on the same date of service?
READ THE ANSWER

PHARMACY​

​

Question:
Can you tell me more about when to use initial service codes versus additional codes for drug administration services?
READ THE ANSWER

RADIOLOGY​

​

Question:
If my provider performs an intervention at the arterial anastomosis, is this defined by arterial angioplasty or stenting codes?
READ THE ANSWER

RESPIRATORY​

​

Question:
If a nurse is furnishing services that do not require the need for a respiratory therapist would the service be separately billable?
READ THE ANSWER

GENERAL​

​

Question:
If a patient has an IV contrast of Isovue 370 for a CT Scan of the Abdomen and oral contrast of 30 ml Gastrografin, do you need to report codes in addition to the CT code? I am being asked about Q9967. This is for hospital billing.
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF APRIL 19, 2021​

CARDIOLOGY​

​

Question:
Is 76377 included in 75561-are there specific circumstances that allow this to be charged and modified? We are using 3D rendering on an independent workstation for post-processing.
READ THE ANSWER

LABORATORY​

​

Question:
What code is used for urine pregnancy testing?
READ THE ANSWER

PHARMACY​

​

Question:
Are the drug screening codes 80100 to 80104 still active?
READ THE ANSWER

RADIOLOGY​

​

Question:
If a film is obtained to verify the position of the clip placed during a needle localization procedure, can we bill this with the unilateral mammogram code 77065?
READ THE ANSWER

RESPIRATORY​

​

Question:
Is MVV required for 94010?
READ THE ANSWER

GENERAL​

​

Question:
I’m being told I need a modifier if I bill 79005 and 78014 together. Do you know which modifier and why?
READ THE ANSWER