Ask Dr. Z

How should we charge for contrast in interventional radiology? Do we charge the amount ordered or the amount us (if we order a vial 100 ml and used/injected only 50 ml) since the amount needed determined at the end of the procedure? My question is regarding if the contrast comes in a premeasured single use vial, and they don’t use all of it they can still bill the amount in the vial because it can’t be reused and what is not used is wasted. Can we charge the entire amount as long as there is documentation of the waste? How do we charge the contrast if it is not a single use vial? Then they can only charge for the amount given? I could not find any guidelines in the CPT Assistant since it is not a CPT code. Would you please inform us with your answer and any reference and guidelines from CMS, HCPCS, or Federal Register to support this. Here is a case scenario to support the question:

Patient is having abdominal aortagram 1.6 Creat.

• 50 ml Iohexol 300 on the table for test dose. 10 ml 50% diluted contrast used for test
• 50 ml Iohexol Injector 40 ml Injected 50% diluted contrast for Aortagram
• 100 ml Iohexol 300 Opened / 25 ml Iohexol 300 actually used

How should we bill?