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?
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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 JUNE 27, 2022​

CARDIOLOGY​

​

Question:
For IFR what is the difference for codes 93571 and 93572? What is the difference in what the codes represent?
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LABORATORY​

​

Question:
What revenue codes are acceptable when reporting the 85XXX series? Is 0300 safe to report?
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RADIOLOGY​

​

Question:
What CPT® codes should be charged when performing a lymphoscintigraphy for pre-operative sentinel node localization? Is there an injection code? Should 38792 be charged?
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RESPIRATORY​

​

Question:
What ICD-10 diagnostic code would we report for COVID-19 testing for asymptomatic patients prior to inpatient admissions, planned outpatient procedures, and immunosuppressant therapies as part of Pre-Procedure Screening for PFT?
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GENERAL​

​

Question:
For respiratory therapy services, what does “room and board” mean?
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[Lori]

FOR THE WEEK OF JULY 4, 2022​

CARDIOLOGY​

​

Question:
An interventional cardiologist places three drug-eluting stents, one in the left circumflex and another in the obtuse marginal branch. A third DES stent is deployed within the left anterior descending coronary artery. Do you have any recommendations for reporting?
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LABORATORY​

​

Question:
What code would I report if the physician has ordered only a CBC with no mention of a differential?
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RADIOLOGY​

​

Question:
Can we report 77067-52-LT and 77065-RT together for a screening mammogram on the left breast and a diagnostic mammogram on the right breast? The patient feels a lump in her right breast, but it’s time for her annual screening mammogram so her doctor wants to complete a screening on the left side.
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RESPIRATORY​

​

Question:
Do you have any tips for documenting medical necessity correctly?
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GENERAL​

​

Question:
What is the peri-anastomotic region?
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[Lori]

FOR THE WEEK OF JULY 11, 2022​

CARDIOLOGY​

​

Question:
Do you have any tips for reporting therapeutic ultrafiltration? What code would we use?
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LABORATORY​

​

Question:
When can you bill for a manual differential or a pathologist’s review of an abnormal smear?
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RADIOLOGY​

​

Question:
We received an order from a referring physician that requested an ultrasound (US) thyroid for nodule assessment and a US soft tissue for a submental mass palpable on the exam. The facility coder believes that the facility should get two charges. The interpretation covers both areas in one report. It is my understanding that head and neck (CPT® 76536) would cover both of these assessments. Am I correct? The evaluation is performed for two separate reasons, but the imaging is of the neck.
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RESPIRATORY​

​

Question:
How do we determine when 88740 and 88741 should be billed separately or bundled? Do you have any advice?
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GENERAL​

​

Question:
What are the differences between codes 75625 and 75630 for an abdominal aortogram?
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[Lori]

For the Week of July 18, 2022​

CARDIOLOGY​

Do you have any tips for reporting therapeutic ultrafiltration? What code would we use?
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LABORATORY​

For microbiology services, is interpretation and report for 87XXX codes separately billable?
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RADIOLOGY​

We received an order from a referring physician that requested an ultrasound (US) thyroid for nodule assessment and a US soft tissue for a submental mass palpable on the exam. The facility coder believes that the facility should get two charges. The interpretation covers both areas in one report. It is my understanding that head and neck (CPT® 76536) would cover both of these assessments. Am I correct? The evaluation is performed for two separate reasons, but the imaging is of the neck.
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RESPIRATORY​

Can physical therapists bill PT codes separately if they conduct assessments and individual treatment services as part of a PR program?
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GENERAL​

What are the differences between codes 75625 and 75630 for an abdominal aortogram?
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[Lori]

For the Week of August 1, 2022​

CARDIOLOGY​

What are the intentions of codes 36470 and 36471 and when should we assign one as opposed to the other?
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LABORATORY​

For fine needle aspirate, what code would we report when the cytotechnologist prepares slides from the needle aspirate and returns these slides to the pathologist for immediate evaluation?
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RADIOLOGY​

Do you know how the proposed 2023 Medicare Physician Fee Schedule (PFS) rule conversion factor impacts radiology-related reimbursement?
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RESPIRATORY​

What are the differences between G0237, G0238, and G0239?
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GENERAL​

What is the difference between a ‘catheter’ and a ‘stent’ in genitourinary procedures?
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[Lori]

For the Week of August 8, 2022​

CARDIOLOGY​

When coding for renal angiography, do you have any tips or guidance for reporting?
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LABORATORY​

In terms of fine-needle aspirate, how do we bill for every pass the pathologist is asked to review for adequacy?
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RADIOLOGY​

What is the correct way to code for an imaging study of an ileal conduit when the injection is performed near where the conduit empties into the external drainage bag (i.e., the skin side of the conduit)?
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RESPIRATORY​

For respiratory rehabilitation services can we use the time in and out of the department to calculate billable units of service?
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GENERAL​

How would you code when a radiologist is asked to create a new access, or enlarge an existing access, for a urologist to perform subsequent endourologic
procedures?
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[Lori]

For the Week of August 15, 2022​

CARDIOLOGY​

For lower extremity incompetent veins treatment services, what code would I report for the chemical ablation of incompetent extremity veins?
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LABORATORY​

What do we report for the technical component of flow cytometry tests for identifying specific cell surface or cytoplasmic markers? How do we report additional markers?
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RADIOLOGY​

What codes would we report for interventions in the central segment of the dialysis circuit?
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RESPIRATORY​

For respiratory rehabilitation services, do you have any tips on billing single and multiple units relative to the time increments?
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GENERAL​

What are the codes for atherectomy in the iliac arteries?
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[Lori]

For the Week of August 22, 2022​

CARDIOLOGY​

If instead, selective renal angiography is performed, can I submit 36251–36254 as appropriate in addition to a cardiac catheterization procedure?
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LABORATORY​

When it comes to reporting cytogenetic studies, is it ok to bill the 8XX99 codes for unlisted procedures?
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RADIOLOGY​

What code would we report for arterial mechanical thrombectomy?
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RESPIRATORY​

When should we report remote physiologic monitoring code 99353?
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GENERAL​

What is a fine needle aspiration (FNA) biopsy and how is this different from a core biopsy?
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[Lori]

For the Week of August 29, 2022​

CARDIOLOGY​

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.
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LABORATORY​

What differences are important to know between code 88305 and 88307 for reporting?
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RADIOLOGY​

Should we report a separate S & I code with intravascular stent codes? Do we charge for angioplasty separately when reporting these codes?
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RESPIRATORY​

Do you have any tips for reporting 95808?
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GENERAL​

Is it ever possible to assign two primary FNA biopsy codes at the same session?
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[Lori]

For the Week of September 5, 2022​

CARDIOLOGY​

Do you have more insight into how we would code for arterial mechanical thrombectomy?
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LABORATORY​

When applying an “antibody cocktail” which contains two or more separately interpretable antibodies do you have any recommendations to determine applicable billable units of service?
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RADIOLOGY​

For lower extremity incompetent veins treatment services, what code would I report for the chemical ablation of incompetent extremity veins?
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RESPIRATORY​

When is code 54250 is non-payable?
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GENERAL​

Can you code both an FNA biopsy and a core biopsy performed at the same session, on the same lesion, using the same type of imaging guidance?
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[Lori]

For the Week of September 12, 2022​

CARDIOLOGY​

What are some of the guidelines for reporting 93572?
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LABORATORY​

For bone marrow studies, it is appropriate to bill separately for duplicative testing on the same or similar specimens? Also, can we append a modifier if the testing in separate departments or laboratories is for the same antibody?
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RADIOLOGY​

Can extremity angiography codes 75710 and 75716 be assigned for selective and non-selective imaging?
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RESPIRATORY​

What codes replaced 95827 and how should we report based on the deletion of this code?
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GENERAL​

Is there a code for removal of a gastrostomy or other colonic tube?
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[Lori]

For the Week of September 19, 2022​

CARDIOLOGY​

What modifier is needed when completing diagnostic cardiac catheterization when performed in conjunction with a coronary intervention?
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LABORATORY​

We noticed that descriptors for both CPT® codes 82803 and 82805 begin with the word “gases,” and had some confusion around measuring. In this case, should it mean that two or more blood gases must be measured? Please advise.
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RADIOLOGY​

How do you know when it is appropriate to report code 36218 for additional 2nd or 3rd order vessels selectively catheterized?
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RESPIRATORY​

What is the intended use of codes 95812 and 95813?
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GENERAL​

What do left heart congenital catheterization codes (93595, 93596, 93597) include?
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[Lori]

For the Week of September 26, 2022​

CARDIOLOGY​

Can you explain more details on what is required in regard to documentation for duplex studies?
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LABORATORY​

Can we bill 36415 for finger sticks or line draws as well as venipuncture?
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RADIOLOGY​

What exactly does 0508T define? Is there any modifier that needs to be reported with this service?
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RESPIRATORY​

When should RPM codes 99453 and 99454 not be reported?
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GENERAL​

What are LCDs in regard to laboratory services?
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[Lori]

For the Week of October 10, 2022​

CARDIOLOGY​

Is completion or follow-up angiography (CPT 75898) separately billable for atherectomy?
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LABORATORY​

When billing for 88362 and 88380 on the same date of service what should we include in the documentation? Is a modifier necessary?
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RADIOLOGY​

If the dictated report states “CT volumetric acquisition was performed,” should a CTA study be reported?
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RESPIRATORY​

For continuous positive airway pressure (CPAP) to be covered, does Medicare require a sleep study to diagnose obstructive sleep apnea (OSA) during the COVID-19 PHE?
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GENERAL​

What is the goal of the MIPS program?
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[Lori]

For the Week of October 17, 2022​

CARDIOLOGY​

Is follow-up angiography separately billed when performed with intracranial embolization? Do you have any other tips for reporting 75898 or 61624?
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LABORATORY​

Can we report 88380 in conjunction with 88381?
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RADIOLOGY​

Usually, we instruct coders that if three-dimensional (3D) reconstruction of images is not described in the medical report, it is appropriate to code for a CT study and not a CTA study. This situation most often arises when physicians dictate notes following a CT of the chest for pulmonary embolism. Often physicians identify such a study as a CTA because during the study they are looking at vessels, but such a study is not really a CTA for coding purposes. When coding a CTA of the abdominal aorta with runoffs (code 75635), if the coder does not see a dictation specifying that a 3D postprocessing technique was used, should the coder code for a CT of the abdomen with contrast, a CT of the right leg with contrast, and a CT of the left leg with contrast? The 3D requirement for a CTA study when coding abdomen with runoff creates an issue if the physician does not document a 3D postprocessing technique.
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RESPIRATORY​

Does additional time affect the assignment for code 95816?
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GENERAL​

What is the key distinction between a standard CT and a CTA?
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[Lori]

For the Week of October 24, 2022​

CARDIOLOGY​

For transcatheter therapy coding, can angioplasty and stent changes be submitted per vessel treated? Do you have any other guidance?
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LABORATORY​

For postmortem examination coding, how are the terms newborn, infant, and macerated stillborn defined?
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RADIOLOGY​

What keywords need to be in the radiology report to assign a CTA code?
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RESPIRATORY​

May clinical staff provide Remote Physiologic Monitoring (RPM) services under general supervision?
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GENERAL​

Are inpatient respiratory therapy services included in room and board?
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[Lori]

For the Week of October 31, 2022​

CARDIOLOGY​

If instead, selective renal angiography is performed, can I submit 36251–36254 as appropriate in addition to a cardiac catheterization procedure?
READ THE ANSWER

LABORATORY​

Do we need a modifier for the submitting claims for screening of Medicare beneficiaries diagnosed with pre-diabetes?
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RADIOLOGY​

Is embolization for pelvic congestion considered one or two surgical fields? Also, how do I code for the diagnostic venograms that are performed during pelvic/ gonadal venography?
READ THE ANSWER

RESPIRATORY​

Can we use the time in and out of the department to calculate billable units of service for respiratory rehabilitation service codes?
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GENERAL​

Must 3D images be permanently stored for CTA studies?
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[Lori]

For the Week of November 7, 2022​

CARDIOLOGY​

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​

What types of tests will be impacted by lab reimbursement cuts if these cuts are finalized for next year?
READ THE ANSWER

RADIOLOGY​

Is embolization for pelvic congestion considered one or two surgical fields? Also, how do I code for the diagnostic venograms that are performed during pelvic/ gonadal venography?
READ THE ANSWER

RESPIRATORY​

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​

Must 3D images be permanently stored for CTA studies?
READ THE ANSWER

 

[Lori]

For the Week of November 7, 2022​

CARDIOLOGY​

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​

What types of tests will be impacted by lab reimbursement cuts if these cuts are finalized for next year?
READ THE ANSWER

RADIOLOGY​

In many instances, physicians are ordering a CT to rule out a pulmonary embolism. Shouldn’t these be performed as CTA exams if they are checking the vessels?
READ THE ANSWER

RESPIRATORY​

Do you have any tips for documenting respiratory rehabilitation services?
READ THE ANSWER

GENERAL​

If the start and stop times are not documented on an infusion, can I bill an IV push?
READ THE ANSWER

 

[Lori]

For the Week of November 21, 2022​

CARDIOLOGY​

A diagnostic cardiac catheterization is performed demonstrating two-vessel coronary disease. Due to contrast load, the procedure is staged. A lesion in the LAD is treated by a DES at the initial session and the right coronary lesion is treated at a separate encounter. Can the injection of the coronary arteries during the second encounter be coded and billed with
code 93454 (coronary angiography only)?
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LABORATORY​

What is the Saving Access to Laboratory Service Act?
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RADIOLOGY​

How do you code for a 3, 6, 9, and 12 o’clock breast mass/lesion since there are no “other specified site” or “unspecified quadrant” codes? ICD-10-CM code N63 (Unspecified breast lump) requires specification of the quadrant of the lump site. The radiology report states, “12 o’clock right breast mass.”
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RESPIRATORY​

May we bill G codes to bill for the demonstration of a nebulizer or an inhaler device?
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GENERAL​

What is the difference between oral hydration and intravenous hydration therapy?
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