RAC program highlights

Several coding issues selected for RAC review were first outlined in the First Quarter 2013 issue of the Coding Clinic for HCPCS newsletter. This is the third in a series of follow-up articles that will provide further detail and clarification regarding several of the topics that are currently under review. Diagnostic colonoscopy, sigmoidoscopy and proctosigmoidoscopy A RAC review may be prompted for diagnostic colonoscopies (45378), sigmoidoscopies (45330) and proctosigmoidoscopies (45300) when the corresponding ICD-9-CM codes do not meet medical necessity. For assistance with this issue, review your local National Coverage Determination(s) and Local Coverage Determination(s), or contact your specific...

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Note:  The following article synopsis was NOT provided by the AHA. It was created by Find-A-Code/innoviHealth.

Article Overview

This article provides a high-level update on selected coding issues under RAC review, with focus areas in diagnostic endoscopy services and fluoroscopic imaging guidance. It is intended for coders, billing staff, and compliance teams who need to understand the scope of the issues being discussed and the types of guidance sources referenced, including Coding Clinic, CPT guidance, and coverage determinations. The article helps readers orient themselves to the general compliance and coding topics under review without replacing the full guidance.

Why This Topic Matters

RAC reviews can affect claim integrity, compliance, and reimbursement. Understanding which service categories and code sets are involved helps coding and billing professionals evaluate whether the full article is relevant to their work.

Article Sections

  1. Diagnostic colonoscopy, sigmoidoscopy and proctosigmoidoscopy

    Discusses endoscopic diagnostic services that were identified for RAC review and the general coverage and necessity context associated with them.

  2. Fluoroscopic imaging guidance

    Addresses imaging guidance reporting in relation to injection procedures and the broader coding guidance sources referenced in the article.

What You Will Learn

  • Which general service categories are discussed in the RAC follow-up article.
  • What broad types of coding guidance and coverage references are associated with the topics.
  • How the article frames the compliance and review context for the services discussed.
  • What kinds of questions coders may need to consider when reviewing the cited topics.

Who Should Read This

  • Medical coders
  • Billing specialists
  • Compliance staff
  • Revenue cycle teams
  • Practice administrators

Codes Discussed

  • CPT: 45378
  • CPT: 45330
  • CPT: 45300
  • CPT: 64479
  • CPT: 64480
  • CPT: 64484
  • CPT: 64490
  • CPT: 64491
  • CPT: 64492
  • CPT: 64493
  • CPT: 64494
  • CPT: 64495

Code Ranges Discussed

  • CPT: 64490-64495
  • CPT: 64479-64484

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