Cardiology Coding Alert

Question: Which CPT code describes carotid IMT screening?

Washington Subscriber

Answer: The code describing this service is 0126T (Common carotid intima-media thickness [IMT] study for evaluation of atherosclerotic burden or coronary heart disease risk factor assessment). A note following 93882 (Duplex scan of extracranial arteries; unilateral or limited study) supports this use: "To report common carotid intima-media thickness (IMT) study for evaluation of atherosclerotic burden or coronary heart disease risk factor assessment, use 0126T."

The procedure involves using ultrasound to measure carotid IMT. The intima and media are the carotid artery wall's two innermost layers. One argument is that monitoring IMT allows physicians to keep an eye on atherosclerosis, intervening earlier than they might otherwise.

Coverage: Be sure to check your policies for coverage as many payers consider the service investigational. For example, Premera Blue Cross, headquartered in Washington, states ultrasonic carotid IMT measurement is investigational, but notes physicians may perform the service as a part of some clinical trials (www.premera.com/stellent/groups/public/documents/medicalpolicy/cmi_009710.pdf).

Similarly, Cigna's policy states that it considers carotid IMT testing investigational and therefore doesn't cover it, specifically listing 0126T (www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0475_coveragepositioncriteria_carotid_intima_media_thickness.pdf).

Remember: You shouldn't report an unlisted code or other Category I CPT code in an attempt to garner payment if there is a more appropriate Category III code available. CPT guidelines instruct, "Category III codes allow data collection for these services/procedures. Use of unlisted codes does not offer the opportunity for the collection of specific data. If a Category III code is available, this code must be reported instead of a Category I unlisted code."