RCC Contrast Media, Supplies & HCPCS Level II Coding 1 — Questions and Answers
Question 1: Which type of iodinated contrast media is associated with a lower risk of adverse reactions due to its osmolality being closer to that of blood?
- High-osmolality contrast media (HOCM)
- Low-osmolality contrast media (LOCM) (Correct answer)
- Ionic contrast media
- Barium sulfate suspension
Correct answer: Low-osmolality contrast media (LOCM)
Low-osmolality contrast media (LOCM) has osmolality closer to blood plasma and is associated with significantly fewer adverse reactions than high-osmolality ionic contrast media.
Question 2: When a CT scan is performed both without and with contrast, what is the correct CPT coding approach when a dedicated combination code exists?
- Report two separate CPT codes, one without and one with contrast
- Use the single CPT code specifying 'without contrast followed by re-imaging with contrast' (Correct answer)
- Report only the 'with contrast' code using modifier 22
- Report only the 'without contrast' code since the enhanced phase is incidental
Correct answer: Use the single CPT code specifying 'without contrast followed by re-imaging with contrast'
CPT provides dedicated combination codes (e.g., 74178 for CT abdomen/pelvis without and with contrast) that must be used instead of unbundling into two separate procedure codes.
Question 3: Which HCPCS Level II code category covers most low-osmolality iodinated contrast agents used for intravascular injection?
- A codes (Medical and Surgical Supplies)
- J codes (Drugs Administered Other Than Oral Method)
- Q codes (Temporary Codes) (Correct answer)
- C codes (Outpatient PPS New Technology)
Correct answer: Q codes (Temporary Codes)
Low-osmolality iodinated contrast agents are reported using Q-codes (temporary HCPCS codes such as Q9965-Q9967), which specify iodine concentration range and are billed per ml administered.
Question 4: Gadolinium-based contrast agents used in MRI are primarily reported using which HCPCS code series?
- Q9965-Q9967 (iodinated contrast by concentration)
- A9576-A9579 (gadolinium-based MRI contrast agents) (Correct answer)
- J0636-J0640 (injectable drug codes)
- C9399 (unlisted drug, outpatient PPS)
Correct answer: A9576-A9579 (gadolinium-based MRI contrast agents)
Gadolinium-based MRI contrast agents are reported with HCPCS A-codes: A9576 (gadopentetate dimeglumine), A9577 (gadobenate dimeglumine), A9578 (gadoxetate disodium), and A9579 (NOS).
Question 5: A facility administers contrast media intravenously during a CT scan. Which separate CPT code should be reported for the IV injection of the contrast agent?
- 96365 (IV infusion, initial, up to 1 hour)
- 90765 (IV push injection for therapy)
- No additional injection code; contrast administration is bundled into the imaging CPT (Correct answer)
- 36000 (Introduction of needle or catheter into a vein)
Correct answer: No additional injection code; contrast administration is bundled into the imaging CPT
Contrast administration (injection) is considered integral to the radiology procedure and is included in the imaging CPT code; it should not be reported separately.
Question 6: Which of the following contrast agents is a microbubble preparation used specifically to enhance ultrasound (echocardiography) imaging?
- Gadobutrol (Gadavist)
- Barium sulfate
- Perflutren lipid microspheres (Definity) (Correct answer)
- Iopamidol (Isovue)
Correct answer: Perflutren lipid microspheres (Definity)
Perflutren lipid microspheres (Definity) is an ultrasound contrast agent reported with HCPCS Q9957, used to improve visualization of cardiac structures during echocardiography.
Question 7: Under the Hospital Outpatient Prospective Payment System (OPPS), how are contrast agents below the CMS packaging threshold typically reimbursed?
- Paid separately under the Physician Fee Schedule
- Packaged into the APC payment for the associated imaging procedure (Correct answer)
- Paid as a pass-through drug under a separate APC
- Denied as non-covered supplies
Correct answer: Packaged into the APC payment for the associated imaging procedure
Under OPPS, contrast agents below CMS's packaging threshold are packaged into the Ambulatory Payment Classification (APC) for the imaging procedure rather than reimbursed separately.
RCC Contrast Media, Supplies & HCPCS Level II Coding 1
Which type of iodinated contrast media is associated with a lower risk of adverse reactions due to its osmolality being closer to that of blood?