How to Code Creatinine Before Contrast

The kidneys release a by-product called creatinine. Patients should have a BUN and creatinine test 30 to 45 days prior to radiology procedures if the patient has certain risk factors such as hypertension, diabetes, renal or vascular disease, or if the patient is over 50 years of age. Testing the BUN/creatinine level before radiology procedures determines a patient's renal risk ratio and type of contrast, if any, to be used. If a patient is in a high-risk category, you may administer contrast in a smaller dosage or not at all. Code these pre-procedural tests separately since they are required several weeks before the actual procedure.

Things You'll Need

• Electronic or paper medical billing form
• Patient's medical chart
• Billing physician or facility's information
• Current Procedural Terminology (CPT) Coding Manual
• International Classification of Diseases, 9th Revision (ICD-9) Code Book

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Instructions

• 1

  Review the patient's medical chart to identify the physician's diagnosis and the reason for the creatinine testing. This will be identified by name or with an ICD-9 diagnosis code. This shows medical necessity to the insurance company for the procedure or testing being performed. Insurance companies will deny claims that do not prove medical necessity.

• 2

  Look up the diagnosis code in the ICD-9 code book. Double checking to ensure diagnosis codes are correct prevents claims from being delayed or denied.

• 3

  Fill in the medical insurance claim form with the patient's personal and insurance information in the top section. All of this information will be in the patient's medical record. Then enter the diagnosis code from step 2 in the second section.

• 4

  Enter the code for creatinine testing in section 3. Radiology facilities use the common code 82565 for this type of diagnostic test. Verify this code in the CPT code manual.

• 5

  Add a modifier to the creatinine code if necessary. Use a -26 professional component modifier if the testing was performed in a laboratory, but the physician is interpreting the results. A radiology or imaging center may bill the creatinine testing if it has received a CLIA Certificate of Waiver or CLIA Moderate or High Complexity Certificate. Include your CLIA number in Item 23 of the CMS 1500 form. The test is billed using a QW modifier.

• 6

  Enter the billing physician or facility's information in the lower section to complete the insurance claim form. Be sure you have completed all of the required fields.

• 7

  Submit the claim form to the insurance company for reimbursement.