The start of the new year is a time to solidify coding and compliance. With IR errors remaining widespread, it is important to examine the foundations of IR coding and reinforce some of the basic principles that foster success, especially for new coders. IR coding remains one of the most complex modalities, with as much as 30% subject to errors. In our special “Back to Basics” series, we will explore several foundational topics worthy of review for coders across the nation to ensure accurate and compliant coding practices.
Many cases involve separate S & I codes, which include imaging guidance. There are both S & I codes for specific procedures and generic guidance. When guidance is included in a complete code, it may be specific to one type of guidance, or it may be generic.
For example, CPT® code 64493 for lumbar or sacral facet joint injection requires either CT or fluoroscopic guidance. If ultrasound or other guidance is used, code 64493 may not be assigned.
| 64493 | Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level |
The CPT® manual is an essential source for clarification and guidance when it comes to this area. The following instruction is included in the Surgery Guidelines section of the CPT manual. “Imaging Guidance: When imaging guidance or imaging supervision and interpretation is
included in a surgical procedure, guidelines for image documentation and report, included in the guidelines for Radiology (including Nuclear Medicine and Diagnostic Ultrasound), will apply. Imaging guidance should not be reported for use of a nonimaging-guided tracking or localizing system (eg, radar signals, electromagnetic signals). Imaging guidance should only be reported when an imaging modality (eg, radiography, fluoroscopy, ultrasonography, magnetic resonance imaging, computed tomography, or nuclear medicine) is used and is appropriately documented.”
Many percutaneous procedures now have two codes: one when imaging guidance is not used and another when it is used. In many, but not all, cases, the “with imaging guidance” code will include the guidance, and a separate guidance code may not be separately billed. An example of this situation is provided below.
| 49082 | Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance |
| 49083 | Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance |
Coders must carefully review documentation, code descriptions, and parenthetical notes in the CPT manual to determine whether a guidance code may be assigned or not. By following these three essential steps coders can help ensure accuracy every time.
Cracking the Challenges of Modality-Specific Guidance Codes
When it comes to biopsies, localizations, and other procedures, finding the right guidance codes can feel like navigating a maze with real risks to accuracy and compliance. Modality-specific guidance codes often come into play when a more specific S&I code isn’t available, or when the base code doesn’t already include guidance. These codes fill in the gaps, ensuring accurate and complete coding for a variety of procedures.
| 76942 | Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation |
| +77002 | Fluoroscopic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device) (List separately in addition to code for primary procedure) |
| +77003 | Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid)(List separately in addition to code for primary procedure) |
| 77012 | Computed tomography guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), radiological supervision and interpretation |
| 77021 | Magnetic resonance imaging guidance for needle placement (e.g., for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation |
Understand that codes 77002 and 77003 are add-on codes and may not be reported without a primary procedure code. The primary codes are listed in the CPT® manual. Instructions in CPT say that injection of contrast during fluoroscopic guidance and localization is an inclusive component of certain codes. However, this does not mean that a fluoroscopic guidance code such as 77002 or 77003 may not be assigned. Instead, it means that you would not assign a separate administration code such as 96372 for contrast injection in addition to 77002 or 77003.
76942 carries a series of stipulations about which codes it can be reported in conjunction with. Do not report 76942 in conjunction with 10004, 10005, 10006, 10021, 10030, 19083, 19285, 20604, 20606, 20611, 27096, 32408, 32554, 32555, 32556, 32557, 37760, 37761, 43232, 43237, 43242, 45341, 45342, 46948, 55874, 64415, 64416, 64417, 64445, 64446, 64447, 64448, 64479, 64480, 64483, 64484, 64490, 64491, 64493, 64494, 64495, 76975, 0213T, 0214T, 0215T, 0216T, 0217T, 0218T, 0232T, 0481T, 0582T.
76000 Fluoroscopy (separate procedure), up to 1 hour physician or other qualified health care professional time
When fluoroscopy is the only service being provided, or fluoroscopic guidance is used but does not fit into one of the more specific codes, 76000 may be assigned. For physician billing, code 76000 is designated as a separate procedure and may not be paid if billed with other codes unless they are unrelated (modifier 59 would be required), or if there is a parenthetical note in the CPT manual allowing the use of 76000 with a specific code.
Under OPPS, code 76000 has a status indicator (SI) of “S.” Addendum D1 of the OPPS rule lists the following as a descriptor of its payment status:
• Procedure or service, not discounted when multiple
• Paid under OPPS; separate ambulatory payment classification (APC) payment.
Previously, code 76001 was available for physician billing when a radiologist or other provider spent more than 1 hour assisting a non-radiologist with fluoroscopy. Note that this code was deleted in 2019.
Equipping coders with the educational tools they need is essential for success for several key reasons that impact both your bottom line and compliance:
1. Accurate Reimbursement
IR procedures are complex and often involve multiple steps or components. Understanding the basics ensures accurate coding, which directly impacts reimbursement. Incorrect coding creates a real risk of underpayment, overpayment, or claim denials that puts your facility under threat.
2. Compliance with Regulations
The government is unforgiving. Healthcare coding is heavily regulated, and IR coding is no exception. Mastering the basics helps coders stay compliant with guidelines from the American Medical Association (AMA) and Centers for Medicare & Medicaid Services (CMS), reducing the risk of audits and penalties.
3. Continuing Education (CE) Units help new medical coders build a strong foundation by enhancing their knowledge of coding systems like CPT, ICD-10-CM, and HCPCS while staying updated with industry changes. It supports certification maintenance, introduces specialization opportunities, and fosters career growth by improving accuracy and confidence. Additionally, CE encourages lifelong learning, professional networking, and demonstrates a commitment to excellence, positioning coders for long-term success.
Fortunately, we have a complete solution tailored to everyone’s specific learning needs. Our Interventional Radiology Coding: A Starter Kit. Three key resources deliver unprecedented expert guidance to master coding conundrums. Explore today.
Stay tuned this month for two new back-to-basics topics that will help foster success in the coming year and beyond.
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