Billing for Low Osmolar Contrast Media
Jeff Majchrzak, BA, RT(R)NMTCB
(Editor’s note: This is part one of a two part article on how to bill for low osmolar contrast media.)
While billing requirements have existed for low osmolar contrast me-dia (LOCM) since 1994, the Health Care Financing Administration (HCFA) clarified several key payment issues only last year (Medicare Hospital Manual [MHM], Transmittal 718, July, 1997). HCFA in-creased the number of ICD-9-CM diagnosis codes that can be used to prove the medical necessity of administering LOCM in intravenous and intra-arterial injections, and it issued a specific revenue code for reporting.
When certain codes are reported, pro-viders may receive a separate, reasona- ble, cost-based payment for LOCM in ad-dition to the radiology procedure pay-ment.
Use with Injections
ICD-9-CM Codes for Intravenous and Intra-arterial Injections of LOCM
History of previous adverse reaction* to contrast material
V14.8 and V14.9
History or condition of asthma or allergy
V07.1, V14.0 through V14.9, V15.0, 493.00, 493.01, 493.10, 493.11, 493.20, 492.21, 493.90, 493.91, 495.0 through 495.9, 995.0, 995.1, 995.2 and 995.3
Significant cardiac dysfunction**
402.00, 402.01, 402.10, 402.11, 402.90, 402.91, 404.00, 404.01, 404.02, 404.03, 404.10, 404.11, 404.12, 404.13, 404.90, 404.91, 404.92, 404.93, 410.00, 410.01, 410.02, 410.10, 410.11, 410.12, 410.20, 410.21, 410.22, 410.30, 410.31, 410.32, 410.40, 410.41, 410.42, 410.51, 410.50, 410.52, 410.60, 410.61, 410.62, 410.70, 410.71, 410.72, 410.80, 410.81, 410.82, 410.90, 410.91, 410.92, 411.1, 415.0, 416.0, 416.1, 416.8, 416.9, 420.0, 420.90, 420.91, 420.99, 424.90, 424.91, 424.99, 427.0, 427.1, 427.2, 427.31, 427.32, 427.41, 427.42, 427.5, 427.60, 427.61, 427.69, 427.81, 427.89, 427.9, 428.0, 428.1, 428.9, 429.0, 429.1, 429.2, 429.3, 429.4, 429.5, 429.6, 429.71, 429.79, 429.81, 429.82, 429.89, 429.9, 785.50, 785.51 and 785.59
Generalized severe debilitation
203.00, 203.01, all codes for diabetes mellitus, 518.81, 585, 586, 799.3, 799.4 and V46.1
Sickle cell disease
282.4, 282.60, 282.61, 282.62, 282.63 and 282.69
*Exceptions: sensation of heat, flushing or a single episode of nausea or vomiting. If the reaction occurs on the LOCM induction visit, use codes describing hives, urticardia, etc. and code E947.8external cause of injury and poisioning.
**Includes recent or imminent cardiac decompensation, severe arrhythmia, unstable angina pectoris, recent myocardial infarction and pulmonary hypertension
Medicare covers the following intrathecal procedure codes: 70010, 70015, 72240, 72255, 72265, 72270, 72285 and 72295. Medicare fiscal intermediaries (FIs) will verify that claims include these codes as well as the ICD-9 codes, which indicate that a required medical condition is met. If not on the claim, LOCM payment will be denied.
When LOCM is used with an intravenous or intra-arterial injection on an outpatient, Medicare will issue payment when the hospital provides documentation of at least one of the following medical conditions:
* a history of previous adverse reaction to contrast material;
* a history or condition of asthma or allergy;
* significant cardiac dysfunction including certain symptoms;
* generalized severe debilitation; and/or
* sickle cell disease.
To receive payment, the medical conditions identified by the ICD-9-CM codes listed in the box must be present. HCFA’s recent additions increase the number of acceptable billing codes to more than 145. Report the ICD-9 code in either principal diagnosis code form locator (FL) 67 or FLs 68-75 (other diagnosis code) on the UB-92.
Tips for Correct Billing
Whether LOCM is covered or not, identify its use by one of the following level II HCPCS codes: A4644 (supply of LOCM–100-199 mgs of iodine), A4645 (supply of LOCM–200-299 mgs of iodine) or A4646 (supply of LOCM–300-299 mgs of iodine).
Also follow HCFA’s LOCM billing instructions listed below.
* Use revenue code (RC) 636 (drugs requiring detailed coding).
* If separately billing, adjust the charge for the radiology procedure to exclude any LOCM amount if your procedure charge includes an amount for the contrast material.
* Based upon the patient’s condition and/or study performed, include appropriate HCPCS or ICD-9-CM codes on the UB-92. If they’re missing, the FI will consider the LOCM to be noncovered in this case and deny payment.
* Never bill LOCM with RC 255 (drugs incident to radiology and subject to the payment limitation) or as part of the radiology procedure.
Some FIs may follow slightly different guidelines. Check your Medicare Part A newsletters to obtain state-specific guidelines.
Providers may bill noncovered LOCM charges to Medicare beneficiaries–as long as patients receive written notice of noncoverage before the service is provided. Part 2 of this article, which will appear in the June 29, 1998, issue of ADVANCE, will address the dilemma that facility managers face in regard to doing this.
Jeff Majchrzak is a director of consulting and a senior health care consultant at Medical Learning Inc. (MedLearn), St. Paul, MN. He is board certified in nuclear medicine technology and radiologic technology and has 13 years of experience in radiology, nuclear medicine and administration.