Compliance Question of the Week – Radiology

What code(s) are assigned for an injection of contrast into the knee joint (or into the hip joint) using fluoro prior to computed tomography (CT) or magnetic resonance imaging (MRI)?

We attempted a stereotactic breast biopsy, and the patient fainted, so the biopsy was canceled for the day. Do we charge for a stereotactic biopsy with supplies since it was attempted or a unilateral diagnostic mammogram since only images were obtained? The biopsy is rescheduled for a second attempt with sedation.

Our facility is doing epidural steroid injection (ESI) in radiology using fluoro. The patient is an outpatient and does not report to the ambulatory surgical unit before or after the procedure. We are using the following CPT code. What revenue code would be used?

64483 Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level

When performing a breast ultrasound on a patient with a known history of cancer, we are being asked to also scan the supraclavicular, infraclavicular and infra-mammary nodes. How would we code this additional scan?

I have a follow-up question regarding the instructions given in the April 23 radiology question for the venous duplex scans of both the upper and lower extremities. The instructions were to add modifier -59 to the second 93970 to indicate that it was a different body area. This follows standard coding guidelines; however, we received a denial from our MAC (WPS or NGS) indicating we were to use modifier -76 based on CMS Transmittal 1702 (https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1702CP.pdf) which states:

For only those instances that involve more than one bilateral procedure and are medically necessary and appropriate, hospitals are advised to report the procedure code with a modifier -76 (repeat procedure or service by same physician) in order for the claim to process correctly. Appending modifier -76 to one of the reported bilateral HCPCS code indicates that the bilateral procedure or service was repeated on the same day for the same patient.

Is this information still applicable?

We are interested in developing an order set with specific codes when providers want to rule out obstruction of arteries and veins prior to heart catheterization. Which of the following would make more sense?

Order/charge out arterial duplex/venous duplex with reduced modifiers since they are only looking at the groins.
Use a “pre-line” order that involves the internal jugular vein, subclavian vein, and common femoral vein but eliminates the jugular and subclavian veins and adds the common femoral arteries.
Order/charge out arterial duplex/venous duplex with reduced modifiers since they are only looking at the groins.

Use a “pre-line” order that involves the internal jugular vein, subclavian vein, and common femoral vein but eliminates the jugular and subclavian veins and adds the common femoral arteries.

When we have a patient who has a lower extremity and upper extremity venous duplex scan (CPT®s 93970 and/or 93971), we sometimes (although rarely) evaluate for an upper and lower deep vein thrombosis (DVT). How should we bill if we image all four extremities?

What codes would be used for a non-PET myocardial perfusion scan?

My radiologist is reading fluoroscopy films done in the operating room by another physician. Can my radiologist bill for the fluoroscopy (76000), or should we bill for the area being imaged (such as a chest X-ray) with a 52 modifier since the fluoroscopy isn’t being performed?

What is the ICD-10 code to use for an unspecified lump in the right breast identified at the 9:00 position? The 9:00 position is not in one of the four quadrants nor is it in the axillary tail or subareolar locations.

A patient came in for a whole body thyroid cancer metastases imaging and a SPECT/CT of the neck and chest also was performed. What CPT® code are we to assign here since there is no CPT code for the SPECT/CT?

When it is appropriate to bill 77073—bone length studies (orthoroentgenogram, scanogram)—with the following codes?
73562 Radiologic examination, knee; 3 views
73564 Radiologic examination, knee; complete, 4 or more views