General Question for the Week of April 12, 2021

General Compliance Question of the Week

Question:

If a patient has an IV contrast of Isovue 370 for a CT Scan of the Abdomen and oral contrast of 30 ml Gastrografin, do you need to report codes in addition to the CT code? I am being asked about Q9967. This is for hospital billing.

Answer:

You should report the contrast HCPCS codes such as low osmolar contrast material Q9967 for Isovue 370 on the claim in addition to the appropriate CPT® code for the CT scan. Medicare does not pay for contrast separately under OPPS as it is considered packaged, but the code should be on the claim because packaged codes are used for future rate-setting among other things. Report Q9967 per ml. Oral high osmolar contrast is a different matter. You can also add Q9963 for Gastrografin (per ml). However, there is a CCI edit, and while it can be bypassed with a modifier, it does not fit the qualifications for bypassing. I would report on Q9967 only.

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