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 APRIL 26, 2021​

CARDIOLOGY​

​

Question:
A patient undergoes an initial insertion of a dual-chamber pacemaker system. An RA lead is implanted. In the RV, 2 leads are implanted – 1 at the apex and 1 at the His bundle. Would this be coded with 33208 only, since the code description contains the word “electrode(s)”? Or, can 33999 be added to 33208 to represent the extra lead/extra work involved?
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LABORATORY​

​

Question:
What is the minimum per-mile travel allowance for 2021?
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PHARMACY​

​

Question:
Why was the reporting mechanism updated for drugs of abuse?
READ THE ANSWER

RADIOLOGY​

​

Question:
Under the scenario that a patient has just an abdominal aorta ultrasound, do we report code 76770 or 76775?
READ THE ANSWER

RESPIRATORY​

​

Question:
I am confused about reporting 94728 can you clarify how it is used?
READ THE ANSWER

GENERAL​

​

Question:
From a claims perspective, what are some red flags when reviewing infusion and injection claims?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF MAY 3, 2021​

CARDIOLOGY​

​

Question:
Do you have any advice for reporting 75630 in regards to documentation?
READ THE ANSWER

LABORATORY​

​

Question:
What is the per flat rate billing per trip in 2021?
READ THE ANSWER

PHARMACY​

​

Question:
What codes should we use for definitive drug procedures that are not specified in code range 80320-80373?
READ THE ANSWER

RADIOLOGY​

​

Question:
When it comes to fine needle aspiration biopsy, Is it ever possible to assign two primary codes at the same session?
READ THE ANSWER

RESPIRATORY​

​

Question:
What are the values required for oximetry?
READ THE ANSWER

GENERAL​

​

Question:
How are incidental services packaged under the OPPS?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF MAY 10, 2021​

CARDIOLOGY​

​

Question:
If we are replacing the entire device for insertion related coding procedures, are we able to report the removal of VAD?
READ THE ANSWER

LABORATORY​

​

Question:
Are there any examples you can give for using P9603?
READ THE ANSWER

PHARMACY​

​

Question:
Does the level II coding system include specific codes for drugs?
READ THE ANSWER

RADIOLOGY​

​

Question:
In regards to nuclear medicine services, what codes were added to the Designated Health Service list?
READ THE ANSWER

RESPIRATORY​

​

Question:
Is there a code to report when a respiratory therapist provides instruction on how to use incentive spirometry in a physician’s office?
READ THE ANSWER

GENERAL​

​

Question:
I’ve heard that MACs will pause claims soon is this true?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF MAY 17, 2021​

CARDIOLOGY​

​

Question:
Do you have any coding guidelines for 92941?
READ THE ANSWER

LABORATORY​

​

Question:
Is ethanol testing coded as a definitive analysis? We keep running into problems when we code for this.
READ THE ANSWER

PHARMACY​

​

Question:
Can tell me more about presumptive testing for drugs of abuse in terms of CPT codes?
READ THE ANSWER

RADIOLOGY​

​

Question:
we did an MIBG scan with whole-body planar images at 24 hours after an injection followed SPECT of the abdomen. Would we code 78802, 78803, or both?
READ THE ANSWER

RESPIRATORY​

​

Question:
For both full full-night PAP titration and split-night services, what code should we report?
READ THE ANSWER

GENERAL​

​

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

 

[Lori]

FOR THE WEEK OF MAY 24, 2021​

CARDIOLOGY​

​

Question:
Do you have any tips in regards to repositioning and code 33993?
READ THE ANSWER

LABORATORY​

​

Question:
I’ve heard HCPCS code 87400 was revised is this true?
READ THE ANSWER

PHARMACY​

​

Question:
In regards to nuclear medicine and radiopharmaceuticals, what codes were added to the Designated Health Service list?
READ THE ANSWER

RADIOLOGY​

​

Question:
Are there separate codes for Pyeloric Ultrasound (US) and ultrasound Abdomen? If so, can these be charged separately if ordered on the same day, same session? Or is it all a US abdomen?
READ THE ANSWER

RESPIRATORY​

​

Question:
For pulmonary rehabilitation in regards to COVID-19, what modifier would we use if the hospital has relocated the PBD without applying for an extraordinary circumstances relocation request?
READ THE ANSWER

GENERAL​

​

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

 

[Lori]

FOR THE WEEK OF MAY 31, 2021​

CARDIOLOGY​

​

Question:
Is the coding of a diagnostic cardiac catheterization different based on the access into the body, for example: radial versus femoral artery?
READ THE ANSWER

LABORATORY​

​

Question:
How was 87426 revised?
READ THE ANSWER

PHARMACY​

​

Question:
What do codes G0480-G0483 and G0659 represent for definitive test methods?
READ THE ANSWER

RADIOLOGY​

​

Question:
What if a patient comes to our department for imaging of the AV – Circuit, but they still have a needle/catheter in place and we perform imaging through this “existing” access. Previously I would use code 75791, but since that code is deleted, how do I code for this imaging in this scenario?
READ THE ANSWER

RESPIRATORY​

​

Question:
Are inpatient RT services included in room & board?
READ THE ANSWER

GENERAL​

​

Question:
If a patient has rheumatoid arthritis and comes in for a methotrexate injection, do we use the chemotherapy injection code?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF JUNE 7, 2021​

CARDIOLOGY​

​

Question:
What should we look for in terms of documentation regarding 75630?
READ THE ANSWER

LABORATORY​

​

Question:
Why was COVID code 86328 established?
READ THE ANSWER

PHARMACY​

​

Question:
Are blood derivatives such as albumin infused for therapeutic treatment of liver failure or diseases such as cirrhosis billed as a biological by the pharmacy?
READ THE ANSWER

RADIOLOGY​

​

Question:
Can you tell me the difference between codes 73040 and 23350?
READ THE ANSWER

RESPIRATORY​

​

Question:
May clinical staff provide Remote Physiologic Monitoring (RPM) services under general supervision?
READ THE ANSWER

GENERAL​

​

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

 

[Lori]

FOR THE WEEK OF JUNE 14, 2021​

CARDIOLOGY​

​

Question:
How is the following scenario coded? A patient has an SVG anastomosed to the LC obtuse marginal (OM). Next, this graft “jumps” to the RC posterolateral branch. Through the vein graft, the OM lesion is treated with angioplasty and bare-metal stenting, and a second lesion in the posterolateral branch of the RC is treated with angioplasty and bare-metal stenting.
READ THE ANSWER

LABORATORY​

​

Question:
What is the intent behind U0002? Is it true that it is reportable for in-house developed tests?
READ THE ANSWER

PHARMACY​

​

Question:
When we perform thyroid metastasis scans, can we report the radiopharmaceutical (RP) HCPCS code, along with codes 78018 and 78020?
READ THE ANSWER

RADIOLOGY​

​

Question:
If we perform a bone density on the hips and forearm can we bill both 77080 and 77081 together?
READ THE ANSWER

RESPIRATORY​

​

Question:
Can we charge 94640 for inhalation treatments provided to inpatients?
READ THE ANSWER

GENERAL​

​

Question:
Our hospital is receiving an edit for CPT® 19285 stating that we need a device code. We use needles for breast localization. Is there an appropriate HCPCS code that I should be adding to the claim?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF JUNE 21, 2021​

CARDIOLOGY​

​

Question:
I’m wondering what the provider documentation requirements are when reporting 93356. What do they specifically have to document in their interpretation to substantiate the myocardial strain imaging charge?
READ THE ANSWER

LABORATORY​

​

Question:
How do we select between codes 88187-88189 for proper reporting?
READ THE ANSWER

PHARMACY​

​

Question:
What are the essential elements of radiopharmaceuticals?
READ THE ANSWER

RADIOLOGY​

​

Question:
Our physician from nuclear medicine wants to charge a consult when he meets with the patients before doing leutathera treatments. He states that he has to see the patient and review their labs and make sure that the plan of care from oncology is something that the patient is able to withstand. Sometimes after the review of this information, he will change the plan of care.
I’m not sure if this visit is something that would be included with the administration of the therapy (I’m thinking the CPT would be 79101?) Do you have any input on whether a consult would be something that would be medically necessary for him to provide the treatment? He thinks it is medically necessary for him to meet with the patient and review all of their labs before he could approve their therapy. He stated that he had spent 40 minutes with the patient that he had yesterday. To me, I would think this would be included with the therapy, but I don’t find anything in writing that I can point to.
READ THE ANSWER

RESPIRATORY​

​

Question:
Does additional time impact the assignment for code 95816?
READ THE ANSWER

GENERAL​

​

Question:
What is your opinion on how to use diagnosis Z18.10 – Retained foreign body fragments, metal – for a new gunshot wound (GSW)? I think of ‘retained’ as being old and embedded, but there are differing opinions in my department. If the patient has a new GSW to the tibia and fibula with fractures and for a chest and abdomen x-ray taken around the same time as the tibia & fibula, they state in the impression, “small metallic fragments project over the left middle to upper lung zone and left lateral abdominal wall, likely from a gunshot wound”, would you use Wound, unspecified to the abdomen and chest walls or retained foreign body fragments, metal? Or neither?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF JUNE 28, 2021​

CARDIOLOGY​

​

Question:
How do we bill for an echocardiogram when we use your product Lumason? We are not a hospital and everything I can find says Q9950 can only be billed with the C codes for the hospital.
READ THE ANSWER

LABORATORY​

​

Question:
Can we link the 36415 code for venipuncture per test?
READ THE ANSWER

PHARMACY​

​

Question:
Have the payment rates in the physician office setting for radiopharmaceuticals changed recently?
READ THE ANSWER

RADIOLOGY​

​

Question:
I am confused about an answer regarding an ultrasound arthritis survey. It has been stated that when multiple joints are imaged ipsilaterally by ultrasound to report an unlisted code. However, if the physician completes 76881 bilaterally questioning arthritis, that would be 76881-50 or RT, LT, because it is not ipsilateral. Is that your understanding as well? Is there more information that you would have on the issue that you could direct me to?
READ THE ANSWER

RESPIRATORY​

​

Question:
Do codes 94014 and 94016 account for other healthcare professionals besides physicians?
READ THE ANSWER

GENERAL​

​

Question:
I have a question regarding the obstetrical (OB) ultrasound documentation guidelines. I know that the uterus and adnexa are required elements, but some of the providers feel that documenting an IUP should be sufficient for the 1st trimester (76801/76802). For codes 76805/76810, the guidelines state maternal adnexa should be reported “when visible.” So, do the doctors not have to document it when it is not visible?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF JULY 5, 2021​

CARDIOLOGY​

​

Question:
Can you please tell me if we can bill 93356 myocardial strain imaging on the facility side?
READ THE ANSWER

LABORATORY​

​

Question:
Is it true the FDA authorized the first STD testing for point of care settings to be used for more near-patient care settings?
READ THE ANSWER

PHARMACY​

​

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

RADIOLOGY​

​

Question:
Are we able to bill for both A9539 and A9540 radiopharmaceutical codes when a ventilation and perfusion scan is performed? Medicare is denying the A9539 code. If not, which codes should we be billing?
READ THE ANSWER

RESPIRATORY​

​

Question:
What is the code for reporting BiPAP?
READ THE ANSWER

GENERAL​

​

Question:
What are the essential elements of radiopharmaceuticals?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF JULY 12, 2021​

CARDIOLOGY​

​

Question:
Where do we find the revenue code to put on our hospital claim for a Swan Ganz catheter used when a right heart catheterization is performed?
READ THE ANSWER

LABORATORY​

​

Question:
Can we use modifier 76 to indicate repeat laboratory services?
READ THE ANSWER

PHARMACY​

​

Question:
How does CMS account for radiopharmaceutical payment if it falls under indicator “N”?
READ THE ANSWER

RADIOLOGY​

​

Question:
If the doctor did an ultrasound of the abdomen to evaluate for ascites, would that be an unlisted code or 76705? He looked at the entire abdomen but did not document the elements required for 76700.
READ THE ANSWER

RESPIRATORY​

​

Question:
How should respiratory therapy bill for ventilation management provided in the emergency department?
READ THE ANSWER

GENERAL​

​

Question:
Regarding the Appropriate Use Criteria (AUC) program, CMS recently stated “Currently, the program is set to be fully implemented on January 1, 2022, which means AUC consultations with qualified CDSMs are required to occur along with reporting of consultation information on the furnishing professional and furnishing facility claim for the advanced diagnostic imaging service. Claims that fail to append this information will not be paid.” Our hospital images are read by an outsourced radiology group. Will the hospital still receive payment for the technical portion if AUC requirements are not met? Will the radiologist’s claim be completely denied?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF JULY 19, 2021​

CARDIOLOGY​

​

Question:
Instead of the diagnostic cardiac cath procedure described in question 8 and the subsequent TPM insertion, what if instead only a percutaneous coronary intervention (PCI) was performed?
If a TPM is inserted/implanted at the same clinical session, can the TPM (i.e., CPT 33210) be coded for and modified in addition to the PCI code?
READ THE ANSWER

LABORATORY​

​

Question:
What is the payment status indicator of P9050?
READ THE ANSWER

PHARMACY​

​

Question:
What is the assignment of code dependent on G0480?
READ THE ANSWER

RADIOLOGY​

​

Question:
What is meant by the term, “independent workstation,” in the descriptors for CPT codes 76376, 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; not requiring image postprocessing on an independent workstation, and 76377, 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; requiring image postprocessing on an independent workstation?
READ THE ANSWER

RESPIRATORY​

​

Question:
When should 36592 be assigned?
READ THE ANSWER

GENERAL​

​

Question:
Our hospital is receiving an edit for CPT® 19285 stating that we need a device code. We use needles for breast localization. Is there an appropriate HCPCS code that I should be adding to the claim?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF JULY 26, 2021​

CARDIOLOGY​

​

Question:
How is the following scenario coded? A patient undergoes angioplasty and bare-metal stenting of a distal LC lesion through a vein graft followed by the placement of a separate drug-eluting stent in the proximal native vessel via a separate access.
READ THE ANSWER

LABORATORY​

​

Question:
If you do the AHG technique, do you report all three of the codes, or just 86922?
READ THE ANSWER

PHARMACY​

​

Question:
Are codes 82542 and 83789 qualitative or quantitative?
READ THE ANSWER

RADIOLOGY​

​

Question:
If “MIP” is stated within the documentation, is that enough to support billing for 3D post-processing? If so, if the location that performed the Technical Component of this exam was not part of the official registry and an independent group of radiologists interpreted and billed for the professional reads for these studies is the radiology group at risk of potentially having to reimburse CMS (Medicare) for the services related to this code?
READ THE ANSWER

RESPIRATORY​

​

Question:
Can we report codes 99453 or 99454 if monitoring is fewer than 16 days?
READ THE ANSWER

GENERAL​

​

Question:
Pre-MRI screening orbit x-rays – we keep getting denials for using T15.90XA due to being unspecified. Do you know what other codes would be appropriate? Would Z18.10 be a useable code for this?
T15.90XA Foreign body on external eye, part unspecified, unspecified eye, initial encounter
Z18.10 Retained metal fragments, unspecified
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF AUGUST 2, 2021​

CARDIOLOGY​

​

Question:
How is the following scenario coded? A patient undergoes angioplasty and bare-metal stenting of a distal LC lesion through a vein graft followed by the placement of a separate drug-eluting stent in the proximal native vessel via a separate access.
READ THE ANSWER

LABORATORY​

​

Question:
If we bill an electronic compatibility test on the same claim with CPT 86920 will this trigger an edit?
READ THE ANSWER

PHARMACY​

​

Question:
Are codes for vascular access and injection of radiopharmaceutical separately reportable?
READ THE ANSWER

RADIOLOGY​

​

Question:
Regarding the Appropriate Use Criteria (AUC) program, CMS recently stated “Currently, the program is set to be fully implemented on January 1, 2022, which means AUC consultations with qualified CDSMs are required to occur along with reporting of consultation information on the furnishing professional and furnishing facility claim for the advanced diagnostic imaging service. Claims that fail to append this information will not be paid.” Our hospital images are read by an outsourced radiology group. Will the hospital still receive payment for the technical portion if AUC requirements are not met? Will the radiologist’s claim be completely denied?
READ THE ANSWER

RESPIRATORY​

​

Question:
Can we bill code 94799 for oxygen?
READ THE ANSWER

GENERAL​

​

Question:
In regards to nuclear medicine and radiopharmaceuticals, what codes were added to the Designated Health Service list?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF AUGUST 9, 2021​

CARDIOLOGY​

​

Question:
What verbiage do I need to see in echocardiogram reports to report 93320/93321 and 93325?
READ THE ANSWER

LABORATORY​

​

Question:
How do we report semi/quantitative in situ hybridization (tissue or cellular) performed by computer-assisted technology?
READ THE ANSWER

PHARMACY​

​

Question:
If two separate nuclear medicine studies are performed on the same date of service, one with the radiopharmaceutical described by HCPCS code A9512 and one with another AXXXX radiopharmaceutical labeled with Technetium Tc-99m can both codes be reported?
READ THE ANSWER

RADIOLOGY​

​

Question:
If we perform a bone density on the hips and forearm can we bill both 77080 and 77081 together?
READ THE ANSWER

RESPIRATORY​

​

Question:
What is the maximum number of sessions that PR will be covered per day?
READ THE ANSWER

GENERAL​

​

Question:
Are non-chemotherapy infusions of pre-mixed electrolyte solutions considered hydration or infusion?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF AUGUST 16, 2021​

CARDIOLOGY​

​

Question:
For Medicare hospital billing, if a planned PTCA is attempted but the balloon cannot be advanced across the lesion, can we bill for the attempted angioplasty?
READ THE ANSWER

LABORATORY​

​

Question:
Can 87088 and 87184 be used in association with 87086?
READ THE ANSWER

PHARMACY​

​

Question:
What are some guidelines for reporting radiopharmaceutical agents A9555, A9526, and A9552?
READ THE ANSWER

RADIOLOGY​

​

Question:
How is MRE different than USE?
READ THE ANSWER

RESPIRATORY​

​

Question:
What should RTR therapies treatments include?
READ THE ANSWER

GENERAL​

​

Question:
If a patient has rheumatoid arthritis and comes in for a methotrexate injection, do we use the chemotherapy injection code?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF AUGUST 23, 2021​

CARDIOLOGY​

​

Question:
For hospital billing, does G0278 have reimbursement or an assigned APC?
READ THE ANSWER

LABORATORY​

​

Question:
Are codes 82542 and 83789 qualitative or quantitative?
READ THE ANSWER

PHARMACY​

​

Question:
What does HCPCS code A9512 describe?
READ THE ANSWER

RADIOLOGY​

​

Question:
We occasionally go to the OR to use ultrasound to assist with D&C, fetal position, lumpectomy, and other procedures. Do we use US intraoperative code 76998?
READ THE ANSWER

RESPIRATORY​

​

Question:
What is the time incriminate that codes G0237 and G0238 should be billed for?
READ THE ANSWER

GENERAL​

​

Question:
What are some examples of documentation indications for a medically necessary fluid replacement for hydration therapy?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF AUGUST 30, 2021​

CARDIOLOGY​

​

Question:
Is code 92973 the appropriate code for aspiration of a thrombus within a coronary vessel?
READ THE ANSWER

LABORATORY​

​

Question:
Is 80050 covered by Medicare?
READ THE ANSWER

PHARMACY​

​

Question:
Can A9512 be reported with other AXXX radipharmaceuticals containing Technetium Tc-99m?
READ THE ANSWER

RADIOLOGY​

​

Question:
Is it appropriate to separately report a specimen radiograph performed after a breast localization procedure?
READ THE ANSWER

RESPIRATORY​

​

Question:
Can we use the time in and out of the department to calculate billable units of service for respiratory rehabilitation service codes?
READ THE ANSWER

GENERAL​

​

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

 

[WhitneyH_24046]

Thanks Lori!