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 complete procedure (injection, supervision and interpretation), submit these procedures on same claim. This applies to paper and electronic claims.
- When submitting any combination of two or more selective injections (CPT codes 36215-36248) on same date of service, identify 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 electronic claims (Loop 2300, or 2400, NTE, 02)
- Select codes for selective catheter based on highest order code for that particular vascular family. Lesser order codes are included and should not be billed separately
- Providers 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 same date of service
- Note: If faxing this additional information with electronic claims, send fax on same day, or one or two days prior to transmitting claim. Use a fax cover sheet with each document and indicate 'FAX' in 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 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 same date
- CPT modifier 59 may only be submitted with component or fragment procedure ('Column II code'). Before submitting a bundled code as an 'exception' for separate payment, verify that Correct Coding edits apply by checking CMS NCCI webpage
- Do not submit CPT modifier 52 with injection procedures (CPT codes 36215-36248)
- CPT modifier 52 is appropriate when claim includes only supervision or only interpretation portion of radiology codes. When using CPT modifier 52 in these situations, indicate which portion of service provider is performing (either supervision or interpretation)
- Submit this information in documentation record for electronic claims (Loop 2300, or 2400, NTE, 02). For paper claims, submit this information as a separate attachment
- Charge for service should be reduced accordingly
Last Updated Jun 15, 2018