Medical Oncology Code Changes
ACOA Coding Minute
Medical coding does not always keep pace with technological advances. A prime example of this situation has occurred with image fusion procedures. The goal of image fusion is to produce a single image dataset from one or more sets of input images. For example, MRI images can be fused to CT slices, or CT slices can be fused to PET scans. In general, the fused images will contain more complete information for treatment planning. According to the CPT Manual, however, if there is no code that exactly describes the service performed, an unlisted code must be reported.
Therefore, code 77399 (Unlisted procedure, medical radiation physics, dosimetry and treatment devices, and special services) is generally recommended when a separate charge for image fusion is reported. Of note, it is not correct to assign code 76375 (Coronal, sagittal, multiplanar, oblique, 3-dimensional and/or holographic reconstruction of computerized axial tomographic, magnetic resonance imaging, or other tomographic modality) for image fusion, since this code is intended to be used with diagnostic imaging studies and not therapeutic treatment planning.
When reporting an unlisted procedure code, such as the unlisted physics code provided above, it is important to include complete information in order to receive reimbursement. Unlisted codes require a detailed report from the physician or facility including time, skill and any necessary specialized equipment necessary to provide the service. In addition, the claim submission should include a detailed description of the procedure performed, clinical journal information and any cost savings experienced by utilizing this procedure. With respect to the charge amount, relate the ‘unlisted’ procedure to an existing procedure in terms of amount of physician or staff work involved or facility resources expended
The use of unlisted procedure codes present a payment challenge for may insurance payors, but the submission of complete information will help ensure appropriate reimbursement.
The complete text of the Official Guidelines is located at: http://www.cdc.gov/nchs/data/icd9/icdguide.pdf
Cindy C. Parman, CPC, CPC-H
principal and co-founder of Coding Strategies, Inc. in Atlanta, GA. Cindy is a current member of the Advisory Board for the American Academy of Professional Coders (AAPC) and a faculty instructor for AMA Solutions, a subsidiary of the American Medical Association. She serves as the Consulting Editor of the Radiology Coding Alert and is on the Editorial Advisory Board of General Surgery Coding Alert and Pain Management Coding Alert.