CT/MR Coder. Including CT, CTA, MRI and MRA Services. Prepared and Published By:

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Dinah Foster
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1 CT/MR Coder 2018 Including CT, CTA, MRI and MRA Services Prepared and Published By: MedLearn Publishing, A Division of MedLearn Media, Inc. 445 Minnesota Street, Suite 514 St. Paul, MN

2 Table of Contents Abbreviations Used in This Publication...v Introduction...1 Navigating this Publication...1 Understanding CT and MRI...1 Billing for CT and MRI...4 National Correct Coding Initiative...5 Medically Unlikely Edits...5 MUE Adjudication Indicator...6 PTP Edits...7 NCCI PTP Modifier Indicators...7 Modifier Descriptions...8 Modifier X{EPSU} Modifiers...9 JW Modifier Guidance...10 Administration or Injection of Contrast Materials...11 Billing for Contrast Material...12 LOCM Codes...13 HOCM Codes...13 MR Contrast Codes...13 Injections and Infusions of Drugs and Substances...14 Contiguous Body Part Imaging and Multiple Procedure Payment Reduction...23 Ordering of Diagnostic Tests...24 ICD-10 Coding System MPFS RVUs and Hospital OPPS Rates...26 Hospital Value-Based Purchasing...30 MACRA...32 MIPS...32 Advanced APMs...32 Tips for Quality Compliance...33 Medicare Recovery Audit Program...34 Comprehensive Medicaid Integrity Program...35 Computed Tomography...37 Head and Neck...37 Chest/Cardiac...45 Spine and Pelvis...57 Upper Extremities...69 Lower Extremities...73 Abdomen...77 Aorta and Arteries...85 Transcatheter Procedures...89 iii

3 Table of Contents Other Procedures (Percutaneous Vertebroplasty, Kyphoplasty or Sacroplasty)...93 Other Procedures (3-D Rendering)...97 Other Procedures (CT Follow-up) Other Procedures (CT Unlisted Diagnostic, Interventional) Other Procedures (CT Guidance) Other Procedures (Guidance for Radiation Therapy) Other Procedures (Bone Density) Surgical Planning Frequently Asked Questions Magnetic Resonance Imaging Head and Neck Chest Spine and Pelvis Upper Extremities Lower Extremities Abdomen Heart Other Procedures Frequently Asked Questions Appendices Appendix A: Ordering Diagnostic Tests Appendix B: Reporting ICD Diagnosis and Procedure Codes Appendix C: Computed Tomography Appendix D: Magnetic Resonance Imaging (Including Spectroscopy and Magnetic Resonance Angiography) Appendix E: CT Procedures, (including LOCM) and MRI Procedures iv

4 Abbreviations Used in This Publication Abbreviations Used in This Publication 2-D Two-dimensional 3-D Three-dimensional AAA Abdominal aortic aneurysm AC Acromioclavicular ACA Affordable Care Act ACR American College of Radiology AMA American Medical Association APC Ambulatory payment classification CAD Computer-aided detection CAH Critical access hospital CCI Correct coding initiative CMR Cardiac magnetic resonance imaging CMS Centers for Medicare and Medicaid Services CNS Central nervous system CT Computed tomography CTA Computed tomographic angiography CTC Computed tomographic colonography DOS Date of service DRA Deficit Reduction Act EEG Electroencephalogram EHR Electronic Health Record EKG Electrocardiogram FI Fiscal intermediary EPs Eligible providers FFS Fee for Service fmri Functional MRI GI Gastrointestinal HAC Hospital acquired condition HIPAA Health Insurance Portability and Accountability Act HOCM High osmolar contrast material imri Intraoperative MRI IQR Inpatient Quality Reporting IV Intravenous IVP Intravenous pyelogram LCD Local coverage determination v

5 Abbreviations Used in This Publication LDCT Low Dose CT LOCM Low osmolar contrast material MAC Medicare administrative contractor MEP Mutually exclusive procedure MIP Maximum intensity projection MPFS Medicare physician fee schedule MPPR Multiple procedure payment reduction MRA Magnetic resonance angiography MRI Magnetic resonance imaging MRS Magnetic resonance spectography MRT Magnetic resonance technology MRV Magnetic resonance venography MS Multiple sclerosis MUE Medically unlikely edits NCCI National correct coding initiative OPPS Outpatient prospective payment system OQR Outpatient Quality Reporting PE Pulmonary embolism PET Positron emission tomography PQRS Physician Quality Reporting System PTP Procedure to procedure (as in PTP edits) RF Radiofrequency R&F Radiographic and fluoroscopic ROM Risk of mortality RVUs Relative value units SC Sternoclavicular SOI Severity of illness TMJ Temporomandibular joint VBP Value-based purchasing vi

Assignable revenue codes: Explanation of services:

Assignable revenue codes: Explanation of services: COMPUTED TOMOGRAPHY Chest/Cardiac Assignable revenue codes: 0350 CT Scan General Classification 0351 CT Scan Head Scan 0352 CT Scan Body Scan 0359 CT Scan Other CT Scans Explanation of services: Known