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?
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PHARMACY

Question:
Can we use hydration codes to report drug infusion?
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RADIOLOGY

Question:
What are the anticipated changes to percutaneous core needle lung biopsy?
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RESPIRATORY

Question:
Do you have any advice for billing oximetry trend studies?
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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?
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[Lori]

FOR THE WEEK OF SEPTEMBER 20, 2021​

CARDIOLOGY​

​

Question:
Is there a specific CPT® code for myocardial perfusion SPECT/CT scan?
READ THE ANSWER

LABORATORY​

​

Question:
How many separately timed specimens can we bill for when reporting 81050?
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PHARMACY​

​

Question:
How do we use 78740?
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RADIOLOGY​

​

Question:
We performed a sentinel node localization on a patient. We injected the radiopharmaceutical, did a lymphangiogram, then sent the patient to surgery. We coded 78195 and 38792 but are getting denied. Do you know what the problem is?
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RESPIRATORY​

​

Question:
Are separate procedure codes for electromyograms included when reporting 94772?
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GENERAL​

​

Question:
If an infusion is stopped because the patient is having an adverse reaction to a drug, can we still charge for the infusion?
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[Lori]

FOR THE WEEK OF SEPTEMBER 27, 2021​

CARDIOLOGY​

​

Question:
How do we bill echocardiogram with intravenous Lumason® contrast in the office?
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LABORATORY​

​

Question:
If an aspiration is done with the preparation of the smears on superficial tissue and without radiologic guidance, what code should we select?
READ THE ANSWER

PHARMACY​

​

Question:
Does the waste policy regarding the JW modifier apply to radiopharmaceuticals?
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RADIOLOGY​

​

Question:
We are beginning to perform abbreviated breast screening magnetic resonance imaging (MRI) scans without and with/without contrast. They have fewer sequences and take about half the amount of time of a regular breast MRI. If done without contrast followed by contrast administration and
imaging, would we report CPT code 77049-52 or an unlisted CPT code?
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RESPIRATORY​

​

Question:
How are codes 95812 and 95813 used?
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GENERAL​

​

Question:
For code 92941 is there a way of determining if the patient has subtotal occlusion or are we strictly left to rely on the physician to document that specific phrase?
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[Lori]

FOR THE WEEK OF OCTOBER 4, 2021​

CARDIOLOGY​

​

Question:
Does code 78434 require pre-authorization?
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LABORATORY​

​

Question:
What different types of classifications determine the medical necessity for reflex testing?
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PHARMACY​

​

Question:
If pre- and post-voiding images of the radiopharmaceutical are obtained and measurements are calculated to determine the
residual urine, how would this be reported?
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RADIOLOGY​

​

Question:
When reporting for appropriate use criteria in the future, what must be included in the claims?
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RESPIRATORY​

​

Question:
Can we report code 94200 when using the forced expiratory volume (FEV1) from the spirogram to calculate an estimated MVV?
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GENERAL​

​

Question:
For code 92941 is there a way of determining if the patient has subtotal occlusion or are we strictly left to rely on the physician to document that specific phrase?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF OCTOBER 11, 2021​

CARDIOLOGY​

​

Question:
Myocardial perfusion scan code 78452 includes multiple studies. Does this have to be rest and stress? What about prone studies?
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LABORATORY​

​

Question:
Can we report modifiers 76 and 77 to resolve NCCI code pair edits?
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PHARMACY​

​

Question:
For definitive drug analysis, can you tell me more about the drug class listing?
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RADIOLOGY​

​

Question:
If my radiologist supervises a physician assistant (PA) performing a procedure in the radiology department of the hospital, and signs off on the report, can the radiologist bill the procedure under his name?
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RESPIRATORY​

​

Question:
Is RPM considered a Medicare telehealth service?
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GENERAL​

​

Question:
We are adjusting off quite a few computed tomography (CT) scans that are performed to follow up a cancer diagnosis after treatment is complete. Our state’s local coverage determination (LCD) covers the cancer diagnosis code but does not cover the “history of” the specific cancer nor does it cover Z08 for completion of treatment. Is there any compliant way around this denial? For instance, can we bill the cancer diagnosis that is covered even though the report states no evidence of recurrence or metastasis?
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[Lori]

FOR THE WEEK OF OCTOBER 18, 2021​

CARDIOLOGY​

​

Question:
Code 92941 is for the treatment of a total or subtotal occlusion during an acute myocardial infarction. Is there a definition of what qualifies as a “subtotal” occlusion?
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LABORATORY​

​

Question:
Are there still coding and compliance risks posed with COVID-19 testing and protocol? Is there potential for audits in the future?
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PHARMACY​

​

Question:
In terms of coding 78481, how should we go about reporting other non-radioactive drugs?
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RADIOLOGY​

​

Question:
What code would be used for a nuclear medicine dacryoscintography? I haven’t run across one of these before.
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RESPIRATORY​

​

Question:
When should 99453 and 99454 not be reported?
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GENERAL​

​

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?
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[AnaA_16709]

Is it appropriate for coder to modify problem list?( example taking off duplicate dx codes or replace two codes into combination codes)- Is this compliance?

 

[Lori]

Is it appropriate for coder to modify problem list?( example taking off duplicate dx codes or replace two codes into combination codes)- Is this compliance?

Amended Medical Records​

Late entries, addendums, or corrections to a medical record are legitimate occurrences in the documentation of clinical services. A late entry, an addendum or a correction to the medical record, bears the current date of that entry and is signed by the person making the addition or change.

Documentation Guidelines for Amended Records - JE Part B - Noridian

View information about how providers must amend and/or make corrections to the medical record when needed.

med.noridianmedicare.com

CMS includes addendum guidelines in the Medicare Program Integrity Manual, Chapter 3, Section 3.2.5 (“Amendments, Corrections and Delayed Entries in Medical Documentation”):

Note that the Manual does not specify a time frame during which amendments, corrections, or delayed entries may occur. However, common sense suggests that entries made weeks or months after the encounter may be viewed as suspect.

Government and third-party payers recommend that each office or organization develop an internal policy regarding addendums.

Making Amendments, Corrections, and Delayed Entries in Medical Documentation

When amendments, corrections, or delayed entries in medical documentation must be made, the Medicare Program Integrity Manual stipulates certain guidelines.

www.aapc.com

Amending the Medical Record - Find-A-Code Medical Coding and Billing Articles

A medical record is a legal document and therefore there is a right way to modify a record and certainly a wrong way as well. All modifications and addendums must follow the guidelines whether it is the provider or ancillary staff that are modifying their own entries. Addendums may be ...

www.findacode.com

 

[Lori]

FOR THE WEEK OF OCTOBER 25, 2021​

CARDIOLOGY​

​

Question:
What is the code we should report for the insertion of a percutaneous ventricular assist device such as the Impella device?
READ THE ANSWER

LABORATORY​

​

Question:
When a single case requires the processing of multiple specimens that and we code for 88362 and 88380 on the same date of service what will documentation require? Is a modifier needed?
READ THE ANSWER

PHARMACY​

​

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

RADIOLOGY​

​

Question:
I have a question regarding the obstetric ultrasounds we do. The exam charge is entered into the system by the technologist performing the exam. We have been seeing a lot of instances where one exam is being selected/billed but the actual reports document not only that exam, but also the documentation requirements are met for another exam. For example, a patient comes in for a nuchal translucency screening, and the report documents the NT but also documents everything for a first-trimester scan. We’re questioning if it is acceptable practice for us to add the charge for the additional exam in these scenarios or does that need a specified order from the referring provider?
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RESPIRATORY​

​

Question:
How is an episode of care defined for coding remote monitoring with physiologic parameters?
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GENERAL​

​

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

 

[Lori]

FOR THE WEEK OF NOVEMBER 8, 2021​

CARDIOLOGY​

​

Question:
As a follow-up to last week’s question, should biventricular lead insertion into the coronary sinus be unsuccessful, what modifier would we use for coding 33224 and 33225 when reporting hospital outpatient claims?
READ THE ANSWER

LABORATORY​

​

Question:
Can we report U0003 and U0004 for antibody testing?
READ THE ANSWER

PHARMACY​

​

Question:
If a provider administers a therapeutic radiopharmaceutical under the hospital OPPS and plans to later perform a diagnostic scan, what should be done about the claim?
READ THE ANSWER

RADIOLOGY​

​

Question:
If a patient is having an ultrasound-guided breast biopsy, codes 19083, as well as an ultrasound-guided lymph node biopsy, 76942, 38505, is it appropriate to code all three codes? Is a modifier allowed on the 76942 since it was for a different lesion?
READ THE ANSWER

RESPIRATORY​

​

Question:
If CPAP is applied during the PSG, can we report with 95782?
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GENERAL​

​

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?
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[Lori]

FOR THE WEEK OF NOVEMBER 15, 2021​

CARDIOLOGY​

​

Question:
In the instance when more than one site in the same vessel is treated with percutaneous transluminal coronary thrombectomy (92973), is it appropriate to report for each site treated?
READ THE ANSWER

LABORATORY​

​

Question:
I’ve heard that CMS changed payment for high throughput testing, is this true? If yes, how so?
READ THE ANSWER

PHARMACY​

​

Question:
Can we bundle the charges for radiopharmaceuticals when introducing them in the lumbar canal as part of reporting 78630?
READ THE ANSWER

RADIOLOGY​

​

Question:
Our radiologist interpreted a right upper and lower quadrant (RUQ and RLQ) ultrasound ordered by the ER physician. The spleen was not examined so we cannot code a 76700 exam. Is it appropriate to code 76705 twice and add a 59 modifier to the second one?
READ THE ANSWER

RESPIRATORY​

​

Question:
When should we report code 95813?
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GENERAL​

​

Question:
We have a patient who received 3 hours of IV hydration. During that time, the patient received 2 different drugs by intravenous push. Can the entire 3 hours of IV hydration be coded with the intravenous push injections?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF NOVEMBER 22, 2021​

CARDIOLOGY​

​

Question:
I am still confused about the changes to the cardiac positron emission tomography (PET) codes made in 2020. Can you help me understand them better?
READ THE ANSWER

LABORATORY​

​

Question:
What are the requirements when ordering HCV screening and what are the guidelines for the frequency limit?
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:
When performing bilateral breast cyst aspirations, do we use 19000 and 19001 or 19000 x 2?
READ THE ANSWER

RESPIRATORY​

​

Question:
We are experiencing some confusion regarding our understanding of “peak flow” and code 94150. Do you have any tips for clarification?
READ THE ANSWER

GENERAL​

​

Question:
What time can be used for infusion stop if the patient is in the clinic and has a negative reaction requiring inpatient admission?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF NOVEMBER 29, 2021​

CARDIOLOGY​

​

Question:
We are confused about the coding for 78451 and 78452. Can you tell us what is the difference between single study myocardial perfusion SPECT (78451) and multiple studies SPECT (78452)? We have experienced problems when reporting 78451 twice.
READ THE ANSWER

LABORATORY​

​

Question:
What are the risks of improper use of modifiers like modifier 59?
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PHARMACY​

​

Question:
Regarding drug payment for those drugs acquired through the 340B Program, are there any updates to the ASP for 2022?
READ THE ANSWER

RADIOLOGY​

​

Question:
Last year I billed G0297 for low-dose CT when performing lung cancer screening. This year I’m getting an edit that this code is invalid. Did the code change?
READ THE ANSWER

RESPIRATORY​

​

Question:
For coding spirometry for infant or child is moderate sedation separately reportable?
READ THE ANSWER

GENERAL​

​

Question:
How will the conversion factor in the Medicare Physician Fee Schedule impact radiology providers?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF DECEMBER 6, 2021​

CARDIOLOGY​

​

Question:
Can we use 92973 to report a service that aspirates thrombus using a catheter such as Diver even if mechanical fragmentation is not involved?
READ THE ANSWER

LABORATORY​

​

Question:
Is it normal to report for each additional antibody stain when it comes to identifying the suspect neoplasm? If so, what codes would we report?
READ THE ANSWER

PHARMACY​

​

Question:
Do we need to report the JW modifier in an OPPS hospital setting when a drug is discarded?
READ THE ANSWER

RADIOLOGY​

​

Question:
Is it appropriate to report modifiers RT and LT for code 73565? Both knees are imaged on the same film.
READ THE ANSWER

RESPIRATORY​

​

Question:
Was code 95827 deleted? If so how do we go about reporting the associated service?
READ THE ANSWER

GENERAL​

​

Question:
What is the status of the appropriate use criteria? Did the final rule provide any updates?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF DECEMBER 13, 2021​

CARDIOLOGY​

​

Question:
Can color-flow Doppler mapping be performed in addition to fetal echocardiography?
READ THE ANSWER

LABORATORY​

​

Question:
I’ve heard that pathologists are facing reimbursement cuts for 2022. Is this true?
READ THE ANSWER

PHARMACY​

​

Question:
Is the AMA’s definitive drug class listing catalog all-encompassing?
READ THE ANSWER

RADIOLOGY​

​

Question:
If we are doing an ultrasound of the abdomen, ovaries, or scrotum and we use Doppler over the same areas do we charge a Doppler complete (93975) or limited (93976) in addition to the body part US code?
.
READ THE ANSWER

RESPIRATORY​

​

Question:
For sleep studies, does Medicare provide reimbursement for an unattended service?
READ THE ANSWER

GENERAL​

​

Question:
What is the difference between concurrent and sequential infusions?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF DECEMBER 20, 2021​

CARDIOLOGY​

​

Question:
When should 37236 not be reported?
READ THE ANSWER

LABORATORY​

​

Question:
We have a policy that we should always perform an automated differential with CBC. Is this ok from a compliance standpoint?
READ THE ANSWER

PHARMACY​

​

Question:
Can we report the infusion of drugs with hydration codes?
READ THE ANSWER

RADIOLOGY​

​

Question:
Please advise if CPT® code 78452 should be coded with 78830. The technique states: A Lexiscan stress protocol was used. 12 mCi of Tc-99m Tetrofosmin was administered intravenously at rest and 43.2 mCi was administered intravenously at stress. Gated SPECT images were obtained and processed. CT images were obtained through the heart. LIMITATIONS: No prone images were obtained. The low-dose CT acquisition was performed only for attenuation correction/activity localization. There is no intravenous contrast, further limiting the CT component of the study.
READ THE ANSWER

RESPIRATORY​

​

Question:
Can you clarify the use of the procedure behind code 958303?
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GENERAL​

​

Question:
Please help me understand when it’s appropriate or not to charge for post-processing 3D imaging.
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF JANUARY 3, 2022​

CARDIOLOGY​

​

Question:
How many times may code 92941 be reported? We treated three vessels during a myocardial infarction (MI).
READ THE ANSWER

LABORATORY​

​

Question:
Are there any new codes for multianalyte assay additions?
READ THE ANSWER

PHARMACY​

​

Question:
Do you have any tips for documenting drugs and biologicals?
READ THE ANSWER

RADIOLOGY​

​

Question:
If a patient had a chest x-ray with a clinical indication of “pre-op for hip surgery,” what would be the best ICD-10-CM code to assign?
READ THE ANSWER

RESPIRATORY​

​

Question:
Are there any new codes for reporting pulmonary rehabilitation services?
READ THE ANSWER

GENERAL​

​

Question:
My doctor documents moderate sedation time as “approximately xx minutes.” Is this appropriate documentation of time?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF JANUARY 3, 2022​

CARDIOLOGY​

​

Question:
How many times may code 92941 be reported? We treated three vessels during a myocardial infarction (MI).
READ THE ANSWER

LABORATORY​

​

Question:
Are there any new codes for multianalyte assay additions?
READ THE ANSWER

PHARMACY​

​

Question:
Do you have any tips for documenting drugs and biologicals?
READ THE ANSWER

RADIOLOGY​

​

Question:
If a patient had a chest x-ray with a clinical indication of “pre-op for hip surgery,” what would be the best ICD-10-CM code to assign?
READ THE ANSWER

RESPIRATORY​

​

Question:
Are there any new codes for reporting pulmonary rehabilitation services?
READ THE ANSWER

GENERAL​

​

Question:
My doctor documents moderate sedation time as “approximately xx minutes.” Is this appropriate documentation of time?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF JANUARY 10, 2022​

CARDIOLOGY​

​

Question:
Can you explain what new code 93319 is used for?
READ THE ANSWER

LABORATORY​

​

Question:
Can you clarify how MUEs are used?
READ THE ANSWER

PHARMACY​

​

Question:
What does therapeutic drug administration include?
READ THE ANSWER

RADIOLOGY​

​

Question:
Would you clarify the use of modifier KX for the fourth PET scan for subsequent treatment strategy? Are hospitals required to use this modifier, or is it just for physicians?
READ THE ANSWER

RESPIRATORY​

​

Question:
For 2022, what is the APC for 94016?
READ THE ANSWER

GENERAL​

​

Question:
When my doctor performs a diagnostic angiogram or interventional procedure such as embolization, what does he need to document?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF JANUARY 17, 2022​

CARDIOLOGY​

​

Question:
What code would be assigned for inserting a new lead into an existing pacemaker? The old right ventricular (RV) lead was capped, and a new RV lead was inserted.
READ THE ANSWER

LABORATORY​

​

Question:
Are there any updates for PAMA in 2022?
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:
Can you provide the correct code for a nuclear medicine scan of the salivary gland? The patient was reported with a right parotid lesion. Images were taken from the head to neck using Tc 99m, and 17 minutes after the injection two ounces of lemon juice were given. Would 78800 be the appropriate code to assign?
READ THE ANSWER

RESPIRATORY​

​

Question:
Can you tell me how new 2022 codes 98975 and 98976 are used?
READ THE ANSWER

GENERAL​

​

Question:
With calcium scoring code 75571, 3D post-processing CPT code 76377 can be coded at the same session with a modifier. My radiologists always do the reformation of images for these studies on a separate workstation. With proper documentation, can I assign CPT code 76377 on those studied?
READ THE ANSWER

 

[Lori]

FOR THE WEEK OF JANUARY 24, 2022​

CARDIOLOGY​

​

Question:
We are confused about the new 2022 codes for congenital cardiac catheterization. Which code is used for studies such as an indicator dilution study like thermodilution when it comes to catheterization for congenital heart defects? What about codes for reporting contrast injections?
READ THE ANSWER

LABORATORY​

​

Question:
What is modifier 33? Is it applicable for testing?
READ THE ANSWER

PHARMACY​

​

Question:
Can you tell me more about what happens when drugs are mapped to revenue code 636?
READ THE ANSWER

RADIOLOGY​

​

Question:
Was code 50395 deleted? If so, are there new codes that replaced 50395 for 2022?
READ THE ANSWER

RESPIRATORY​

​

Question:
What is the APC for new codes 94625 and 94626?
READ THE ANSWER

GENERAL​

​

Question:
One of my physicians is asking why they have to document the percentage of stenosis instead of mild, moderate, or severe. Do you have any insight?
READ THE ANSWER