Contrast Media, Supplies & HCPCS Level II Coding Flashcards

A hospital outpatient CT angiography uses 100 ml of iopamidol 370 mg/ml iodine concentration. Which HCPCS code correctly describes this low-osmolality contrast?

Answer: Q9967 (LOCM, 300-399 mg/ml iodine, per ml)

Iopamidol 370 mg/ml has an iodine concentration of 370 mg/ml, which falls in the 300-399 mg/ml range, corresponding to HCPCS Q9967.

Which HCPCS code is specifically assigned to gadoxetate disodium (Eovist/Primovist), a hepatocyte-specific MRI contrast agent used for liver imaging?

Answer: A9578

A9578 is the HCPCS code for gadoxetate disodium (Eovist), a hepatocyte-specific MRI contrast agent, while A9576 is gadopentetate dimeglumine, A9577 is gadobenate dimeglumine, and A9579 is gadolinium NOS.

When a patient with documented contrast allergy receives injectable premedication (e.g., methylprednisolone, diphenhydramine) at the facility before a contrast-enhanced CT, how should the premedication drugs be reported?

Answer: Separately, using the appropriate HCPCS/J-codes for each injectable drug administered

Injectable premedication drugs administered in the facility to prevent contrast reactions are separately billable using appropriate HCPCS/J-codes in addition to the imaging procedure code.

Barium sulfate administered for an upper GI (UGI) series in a hospital outpatient setting is typically handled under OPPS as:

Answer: Packaged into the APC payment and not separately reimbursed by Medicare

Barium sulfate for GI studies falls below CMS's packaging threshold and is packaged into the APC payment under OPPS, making it non-separately reimbursable to the outpatient facility.

Under Medicare Advantage (MA) plans, which imaging service is most commonly subject to prior authorization requirements related to contrast use?

Answer: MRI brain with gadolinium contrast for headache evaluation

Many Medicare Advantage plans require prior authorization for advanced imaging studies with contrast such as MRI with gadolinium, as these represent higher-cost services subject to utilization management.

A radiologist performs a fluoroscopy-guided joint injection and uses non-ionic iodinated contrast to confirm needle placement. The contrast volume used is 2 ml of ioversol 320 mg/ml. How should this contrast be coded?

Answer: Reported on the facility/technical claim using Q9966 × 2 units (per ml)

Ioversol 320 mg/ml (200-299 mg/ml range — wait, 320 falls in 300-399) falls in the 300-399 mg/ml range (Q9967), but the principle is that contrast is reported on the facility/technical claim using the correct HCPCS Q-code per ml used.

A radiology coder reviews a CT chest order noting 'CT chest with and without contrast.' The correct CPT code to report is:

Answer: 71270 (CT thorax, without contrast followed by re-imaging with contrast)

CPT 71270 describes CT of the thorax performed without contrast followed by re-imaging with contrast (the combined 'with and without' study), and is the correct code when both phases are performed.