Gastroenterology Coding Alert

Here are the indications you must meet to reap 0067T reimbursementChanges may be on the horizon for virtual colonoscopies, thanks to an American College of Radiology Imaging Network (ACRIN) trial, and it's up to you to be up-to-date on all of gastroenterology's new technologies.Here's what you need to know about reporting these services now.Define CT ColonoscopiesWhat they are: CT colonography (virtual colonoscopy) is an enhanced abdominal CT scan in which computer reconstruction allows physicians to perform a detailed longitudinal 3-D examination of the bowel for polyps, cancer, or other disease. This procedure uses helical computed tomography of the abdomen and pelvis to visualize the colon lumen, along with 3-D reconstruction. Note: The test requires colonic preparation similar to that required for standard colonoscopy (instrument colonoscopy) and air insufflation to achieve colonic distention.For this service, you'll report CT colonography codes 0066T (Computed tomographic [CT] colonography [i.e., virtual colonoscopy]; screening) or 0067T (... diagnostic), says Kelli Pekios, patient accounts manager at Gastroenterology Consultants SC in Moline, Ill.Important: These Category III codes are global codes, meaning they include both the technical (modifier TC, Technical component) and physician reading fee (modifier 26, Professional component). Therefore, to bill for the whole service, your gastroenterologist needs to have training in reading CT scans and colonography.Strike Reimbursement for 0066T -- for NowMedicare does not cover 0066T, the CT colonography code for screening. However, CMS periodically revises screening benefits, and many think this may soon change.Here's why: "Most physicians and much of the public have embraced full colon imaging as the optimal colorectal cancer prevention approach, because the whole colon is at risk and because polyp detection and removal prevents cancer before it starts," says Douglas K. Rex, MD, professor of medicine and director of endoscopy in the Division of Gastroenterology & Hepatology at Indiana University Medical Center in Indianapolis."With the publication of the American College of Radiology Imaging Network trial, guideline groups will likely reconsider CTC as an option for screening" and you'll see a "renewed pressure for a Category I CPT code," Rex says.Discover Diagnostic IndicationsHowever, you may have more luck with receiving reimbursement for diagnostic CT colonographies (0067T), but you'll have to get your supporting ICD-9 codes and documentation in perfect order.For example, National Heritage Insurance Company (NHIC) of Indiana "does not consider routine use of CT colonography for diagnosis to be an established intervention that is reasonable and necessary." Instead, NHIC considers CT colonographies medically necessary when "diagnostic optical colonoscopy has failed or is incomplete due to obstruction, and where the results of CT colonography are likely to impact further patient management."In other words, when a patient with signs or symptoms of a disease undergoes an incomplete diagnostic optical colonoscopy (because of neoplasm, stricture, [...]