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Coding a complete interventional radiology procedure is an intricate and sometimes complicated process. This is because the injection procedures and the angiography supervision and interpretation procedures are represented by different CPT codes.
To eliminate unnecessary claim denials or reviews, claims for the complete procedure should be coded using the following principles below:
- When performing the complete procedure (injection, supervision and interpretation), submit these procedures on the same claim. This applies to paper and electronic claims.
- When you submit any combination of two or more selective injections (CPT codes 36215-36248) on the same date of service, identify the vessels that have been selectively catheterized into the documentation record (e.g. RICA-right internal carotid artery, LCCA-left common carotid, Rt. Subclavian and Lt. Vertebral) of the electronic claims (Loop 2300, or 2400, NTE, 02)
- Select codes for selective catheter based on the highest order code for that particular vascular family. Lesser order codes are included and should not be billed separately.
- You may submit a signed operative or radiology report with any requests for redetermination, electronic claims or as an attachment for paper claims when any combination of two or more injection codes (CPT codes 36215-36248) and angiography supervision and interpretation codes (CPT codes 75600-75774) are submitted on the same date of service
- Note that if you are faxing this additional information with electronic claims, send the fax on the same day you transmit the electronic claim or one or two days prior. Please use a fax cover sheet with each document and indicate 'FAX' in the documentation record (Loop 2300, or 2400, NTE, 02).
Many of the selective injection codes and angiography supervision and interpretation codes are bundled as part of the Correct Coding Initiative:
- Submit CPT modifier 59 when the documentation supports a different session or patient encounter, different procedure or surgery, different site or organ system, separate incision or excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily done on the same date
- CPT modifier 59 may only be submitted with the component or fragment procedure ('Column II code'). Before submitting a bundled code as an 'exception' for separate payment, please verify that Correct Coding edits apply by checking the CMS NCCI Web page.
- Do not submit CPT modifier 52 with injection procedures (CPT codes 36215-36248)
- CPT modifier 52 is appropriate when the claim includes only the supervision or only the interpretation portion of the radiology codes. When using CPT modifier 52 in these situations, indicate which portion of the service you are performing (either the supervision or the interpretation).
- Submit this information in the documentation record for electronic claims (Loop 2300, or 2400, NTE, 02). For paper claims, submit this information as a separate attachment.
- The charge for the service should be reduced accordingly