Laureen: Okay, radiology coding contrast question.
Theresa states, ìIím so confused.
Can you please go over the paragraph entitled, ëAdministration of Contrast Materialí in
the Radiology Guidelines on page 361 of the CPT manual, in particular, the 2nd paragraph
regarding arthrography?
Also, does the 2nd paragraph correlate with Laureenís chart for administration of a contrast
or is it totally unrelated?î
So letís go to our answer sheet here.
This is a scan of my guideline page about administration of contrast.
Now if youíve listened to these before, you know youíve heard me say Iím a very visual
learner.
When I see paragraphs like this, Iím like, ìOh dear God, help me make it visual.î So
this was the initial attempt where we were underlyingÖ so letís just kind of read and
then Iím going to show you my visual attempt and see what you like better.
So first thing you have to understand with contrast is oral and rectal.
For radiology coding purposes, does that count.
You canít code any of the radiology codes that say with contrast if it was given orally
or rectally.
Okay so the phrase ëwith contrastí using the codes for procedures performed using contrast
for imaging enhancement represents contrast material administered.
And these are the 3 separate ways ñ intravascularlyÖ so theyíre going into a vessel and that means
vein or artery.
And then intraarticularly.
A lot of people mix it up and think that means the artery.
Itís articularly which is talking about the joints.
And then intrathecally which means into the spineÖ so a little note there that it means
into spine.
So then this first paragraph talks about for intraarticular injection, use the appropriate
joint injection code.
So the guidelines are letting us know, in addition to the radiology code, we can also
code a joint injection code.
If radiographic arthrography is performed, also use the arthrography supervision and
interpretation code.
So in order to get that needle into that joint space, youíre probably going to need some
imaging to help you do that which is ironic because youíre doing it in order to do xray
or CT scan or whatever.
Okay so thatís what this is saying.
Itís basically a permission statement letting you know what you can code in addition to
the regular radiology code.
Then it says if a CT or MR arthrography are performed without radiographic arthrography,
use the appropriate joint injection code, the appropriate CT or MR code, the ones that
say with contrast of course, and then the appropriate imaging guidance code for needle
placement.
Is it getting confusing enough for you?
So look at this, thatís even more crazy.
So Iím going to go right down to my nice table.
Now I feel better.
So basically, this is how I broke it down.
Whatís the contrast type ñ oral, rectal, intravascular, intraarticular, etc?
Whatís the study type?
Is it with contrast or without contrast which is also called a dry study, by the way, with
contrast which is also called a wet study?
And then are there additional codes that we can bill?
And then is fluoroscopy included?
Fluoroscopy is likeÖ the way I always remember it is picture the 3 Stooges where they used
to run behind that x-ray machine and you can see their skeleton kind of dancing.
Itís like a moving x-ray and itís used a lot for guiding needles and things like that.
So oral and rectal, as we discussed, you cannot code as a study with contrast.
You could only code the one that says without contrast.
And itís very hard for new coders because when they read the scenario, they see the
word ëcontrastí and they want to code the indented code that says with contrast.
But coding-wise, you canít, okay?
If you are injectingÖ if the documentation is saying thereís dye or contrast material
being injected into a vein or artery, you can code that as a study with contrast.
But there are no additional codes.
You canít code the injection code for the vein.
There are codes in the medicine section for that but youíre not allowed to bill that
separately.
Itís bundled into the indented with contrast code.
Then if you do it in a joint, intraarticularly, thereís actually two ways to do that.
You can do the x-ray method or the CT or MR method.
And thatís where that paragraph was getting all confusing and why this questioner was
asking this.
So if itís the x-ray intraarticular type, you can code it one of the indented with contrast
codes and now, youíre allowed to code a joint injection code.
The difference between the x-ray type and the CT MR type is the fluoroscopy is included
in the x-ray type but itís not in the CT or MR type.
That you can code separately if you do it.
And then finally, intrathecally, the spine one, you are allowed to code the indented
with contrast codes of course.
And in addition, you can code on of these spine injection codes - 61055 is for the very
top cervical spine space and then these are for the rest, 66284.
And you can code fluoroscopy separately.
So hopefully, this little table will help you.
I do haveÖ if you go to the discussion board, Iíve shared this link and Iíve uploaded
this as a PDF file on a site called Scribd.
So you can actually print this out and have a copy for yourself.
Boyd: Awesome.
Good stuff.
Laureen: Alright.
Just making sure everyoneís awake.
Okay, Alicia.
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