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Coding for IV contrast dose for CT scan of abdomen

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Q.

If a patient has been administered an IV contrast dose of ISOVUE®-370 (Iopamidol injection) for a CT Scan of the Abdomen and GASTROGRAFIN® (diatrizoate meglumine and diatrizoate sodium solution USP), do you need to report codes in addition to the CPT® code describing the CT imaging? I am being asked about Level II HCPCS code Q9967. This question relates to hospital billing. 

A.

You should report the Level II 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 reimburse hospitals 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 Level II HCPCS code Q9967 per ml.

Oral high osmolar contrast is a different matter. You can also add Level II code Q9963 for GASTROGRAFIN (per ml), however, there is a CCI edit. While it can be bypassed with a modifier, it does not fit the qualifications for bypassing. I would report Level II HCPCS code Q9967 only. 

INDICATIONS AND USAGE | IMPORTANT SAFETY INFORMATION

ISOVUE® (Iopamidol Injection)

Indications and Usage:

ISOVUE®-200, 250, 300, 370

ISOVUE® (Iopamidol Injection) is indicated for angiography throughout the cardiovascular system in adults, including cerebral and peripheral arteriography, coronary arteriography and ventriculography, selective visceral arteriography and aortography, peripheral venography (phlebography), and in pediatric patients for angiocardiography, or for adult and pediatric intravenous excretory urography and intravenous adult and pediatric contrast enhancement of computed tomographic (CECT) head and body imaging.

ISOVUE®-300 (Iopamidol Injection 61%) and ISOVUE®-370 (Iopamidol Injection 76%) Imaging Bulk Package*

ISOVUE® (Iopamidol Injection) Imaging Bulk Package (IBP) is indicated for angiography throughout the cardiovascular system in adults, including cerebral and peripheral arteriography, coronary arteriography and ventriculography, selective visceral arteriography and aortography, peripheral venography (phlebography), and in pediatric patients for angiocardiography; or for intravenous contrast enhancement of computed tomographic (CECT) imaging of the head and body in adult and pediatric patients.

*The ISOVUE (Iopamidol Injection) Imaging Bulk Package is for use with an automated contrast injector or a contrast management system approved or cleared for use with it.

Indications and Usage for ISOVUE®-250 (Iopamidol Injection 51%) Pharmacy Bulk Package**

ISOVUE® (Iopamidol Injection) Pharmacy Bulk Package (PBP) is indicated for adult and pediatric intravenous excretory urography.

**The ISOVUE (Iopamidol Injection) Pharmacy Bulk Package is Not for Direct Infusion.

IMPORTANT SAFETY INFORMATION:

ISOVUE (Iopamidol Injection) IS NOT FOR INTRATHECAL USE. Iopamidol Injection is available as ISOVUE-M 200 (Iopamidol Injection 41%), and ISOVUE-M 300 (Iopamidol Injection 61%) for intrathecal administration. 

Nonionic iodinated contrast media inhibit blood coagulation, in vitro, less than ionic contrast media. Clotting has been reported when blood remains in contact with syringes containing nonionic contrast media. Serious, rarely fatal, thromboembolic events causing myocardial infarction and stroke have been reported during angiographic procedures with both ionic and nonionic contrast media. Therefore, meticulous intravascular administration technique is necessary, particularly during angiographic procedures, to minimize thromboembolic events. 

As with all injectable contrast agents, the possibility of severe reactions should be borne in mind, regardless of the patient’s pre-existing medical history. As with any other iodinated contrast media, caution must be exercised in patients with severely impaired renal function, combined renal and hepatic disease, combined renal and cardiac disease, severe thyrotoxicosis, myelomatosis, or anuria, particularly when large doses are administered. Severe cutaneous adverse reactions (SCAR) may develop from 1 hour to several weeks after intravascular contrast agent administration.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit  www.fda.gov/medwatch or call 1-800-FDA-1088.

Please see full Prescribing Information for ISOVUE (Iopamidol Injection) here. 

Please see full Prescribing Information for ISOVUE Imaging Bulk Package products here. 

Please see full Prescribing Information for ISOVUE (Iopamidol Injection) Pharmacy Bulk Package here.

ISOVUE-M is currently manufactured for Bracco Diagnostics Inc. at three locations: BIPSO GmbH, Singen (Germany), Patheon Italia S.p.A., Ferentino (Italy) and S. M. Farmaceutici SRL, Tito (Italy).

ISOVUE-M is a registered trademark of Bracco Diagnostics Inc.

INDICATIONS AND USAGE | IMPORTANT SAFETY INFORMATION

GASTROGRAFIN® (diatrizoate meglumine and diatrizoate sodium solution USP)

Indications and Usage:

GASTROGRAFIN® (diatrizoate meglumine and diatrizoate sodium solution USP) is indicated for radiographic examination of segments of the gastrointestinal tract (esophagus, stomach, proximal small intestine, and colon). The preparation is particularly indicated when a more viscous agent such as barium sulfate, which is not water-soluble, is not feasible or is potentially dangerous.

GASTROGRAFIN (diatrizoate meglumine and diatrizoate sodium solution USP) may also be used as an adjunct to contrast enhancement in computed tomography of the torso (body imaging); the preparation is indicated, in conjunction with intravenous administration of a radiopaque contrast agent, when unenhanced imaging may not provide sufficient definition in distinguishing normal loops of bowel from adjacent organs or areas of suspected pathology.

IMPORTANT SAFETY INFORMATION:

Not for parenteral use; do not inject. For oral or rectal administration only. It should be kept in mind that serious or anaphylactoid reactions that may occur with intravascular administration of radiopaque contrast agents are theoretically possible following administration by other routes. Patients at increased risk include those with a history of a previous reaction to a contrast medium, patients with a known sensitivity to iodine per se, and patients with a known clinical hypersensitivity (bronchial asthma, hay fever and food allergies). 

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Please see full Prescribing Information for GASTROGRAFIN (diatrizoate meglumine and diatrizoate sodium solution USP) by clicking here.

GASTROGRAFIN is manufactured for Bracco Diagnostics Inc., Monroe Township, NJ 08831, by Therapex, Division of E-Z-EM Canada, Inc., Anjou, Quebec, Canada.

GASTROGRAFIN is a registered trademark of Bracco Diagnostics Inc.