Cardiology Coding Alert

Question: Can you tell me which CPT^® code I should report for carotid IMT screening?

Montana Subscriber

Answer: To report carotid intima-media thickness (IMT) screening, you would look to 0126T (Common carotid intima-media thickness [IMT] study for evaluation of atherosclerotic burden or coronary heart disease risk factor assessment).

In the CPT^® 2017 manual, a note following 93882 (Duplex scan of extracranial arteries; unilateral or limited study) says, “To report common carotid intima-media thickness (IMT) study for evaluation of atherosclerotic burden or coronary heart disease risk factor assessment, use Category III code 0126T.”

The IMT allows the cardiologist to monitor atherosclerosis and evaluate for cardiovascular disease. During this procedure, the cardiologist performs an ultrasound on the carotid artery to measure the thickness of the intima and the media — the two inner layers of the artery.

Coverage:  Be sure to check your policies for coverage since many payers consider this service investigational. For example, Cigna’s policy says, “Cigna does not cover carotid intima-media thickness (CIMT) testing for any indication including the evaluation of atherosclerotic burden or coronary heart disease risk factor assessment because it is considered experimental, investigational or unproven.”

You can read Cigna’s policy in its entirety at https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0475_coveragepositioncriteria_carotid_intima_media_thickness.pdf.

Remember: You should never report an unlisted code or other Category I CPT^® code to garner payment if there is a more appropriate Category III code choice available.

“Category III codes allow data collection for these services/procedures,” according to CPT^® 2017. “Use of unlisted codes does not offer the opportunity for the collection of specific data.”

CPT^® adds that if there is an appropriate Category III code available, you must report that code, not the Category I unlisted code.