Take the VooDoo out of Coding and Compliance

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By Melody Mulaik, MSHS, CRA, FAHRA, RCC, CPC, CPC-H

Very soon we will gather together in New Orleans to celebrate all things AHRA: networking, education, and of a course a little bit of fun. This Spring Conference looks to be one of the best yet with a diverse offering of sessions that are guaranteed to ensure that every radiology administrator gains valuable information.

I will be presenting a session entitled “Take the VooDoo out of Coding and Compliance” a fun play on words for the unique city that is indeed the voodoo capital of America. I have no additional commentary on voodoo so I will stop there!

For better or worse, the world of radiology coding and compliance is ever changing. Some years we have big changes, and other seem to just offer a few minor updates. This year is a little bit of a mixture. While some of the changes are relatively straightforward, like the new abdominal and chest x-ray codes, their impact to operations had a bigger impact that some people may have realized. Additionally, incorrect edits were implemented by CMS, which created some unexpected challenges to appropriate reimbursement. These new codes, along with all of the other new codes for 2018, will be reviewed in the session to ensure appropriate implementation and identification of any current challenges.

Challenges for existing codes, like lung cancer screening, PET, and more, will also be reviewed to discuss new guidelines updates and current reimbursement challenges. For example, are you aware that in the 2018 National Correct Coding Initiative Policy Manual (NCCP) CMS issued a new policy on coding for diagnostic CT with PET-CT? When a diagnostic CT scan is performed on a PET-CT scanner, the provider must report the PET scan using a code from PET only series 78811-78813 (versus PET-CT codes 78814-78816). These codes represent PET scans without a concurrently acquired CT. The diagnostic CT scan can be reported with the appropriate CT code, and modifier 59 or XU can be applied to the CT code.

The NCCI Policy Manual states:

If the data set for the diagnostic CT is obtained concurrently on the same PET/CT integrated system where the CT portion of the study is co-registered with the PET images for the purpose of attenuation correction and anatomic localization, the diagnostic CT CPT® code may be reported with PET CPT® codes 78811-78813 utilizing an NCCI-associated modifier.

The manual states that a CT code should not be assigned together with a PET-CT code unless the PET-CT and the diagnostic CT are performed on “separate pieces of equipment.” This new guidance was a surprising addition in the 2018 NCCP Manual.

Are you sure you are up to date on what you need to know to ensure correct coding for 2018? If not, come to New Orleans and take the voodoo out of your coding and compliance!

Melody W. Mulaik, MSHS, CRA, FAHRA, RCC, CPC, CPC-H is the president of Coding Strategies, Inc. She is also a member of the AHRA Regulatory Affairs Committee. She can be reached at Melody.mulaik@codingstrategies.com.  

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