Radiology

For the Week of May 2, 2017

In a previous radiology Q&A, you indicated that the HCPCS code for Gastrografin is Q9963 (high osmolar contrast material [HOCM], 350–399 mg/ml iodine concentration, per ml) and that barium products such as Readi-Cat® Smoothies are considered supplies and do not have HCPCS codes.
Can you elaborate more on this? Are you recommending that we report Q9963 for studies involving Gastrografin, for patients who drink or receive oral and/or rectal contrast? 

We aren’t “recommending” that you do code them, but saying that if your payer allows it, that is the correct code to report.  

For Medicare, HOCM, oral contrast and rectal contrast are considered included in the payment for the scan. Barium is always considered a supply and does not have a HCPCS code. Other contrast material, such as Gastrografin, does have a HCPCS code, which has a status indicator of “N” (packaged) under the outpatient prospective payment system (OPPS). For hospital billing under OPPS, you could list that code, but it would not be separately paid. (The same goes for any other type of contrast other than low osmolar contrast material [LOCM] that is administered via intravenous, intrathecal or intra-articular injection.) 

Other payers may or may not pay separately for HOCM. At one time, Aetna said that they would pay for HOCM but that may or may not be true now or not and the circumstances for payment may vary. It is important to understand the policies of the individual payer to know whether these codes are allowed.