Medicare Compliance & Reimbursement
Why You May Get Paid For More Chest Radiograph CADs
You may be able to bill for chest radiograph CAD code 0152T on its own starting in January.
Currently, you can only bill for this code in addition to chest X-ray codes 71010, 71020-71022 and 71030. Reason: When the CPT Editorial Panel introduced 0152T, it assumed that you'd only bill for the CAD along with an X-ray, says Michael Longacre, a consultant with Healthcare Market Strategies in Yamhill, OR. But some practices have been performing the CAD without a chest X-ray, for example to interpret an X-ray that happened on a previous date.
So Miamisburg, OH-based Riverain Medical, which makes the chest radiograph CAD, suggested to the CPT Editorial Panel that it remove the add-on designation from 0152T. The panel considered this suggestion at its meeting in Las Vegas June 9-10, and a decision should be forthcoming this fall.
Since the purpose of a Category III code like 0152T is to collect data on how often you're performing a procedure, it's important to recognize every use of a procedure, not just some, says Longacre, who works with Riverain.
Medicare designated 0152T as "carrier priced," but so far at least one Medicare carrier and some supplemental Medicare payors have been reimbursing it, Longacre says. Tip: Longacre's company published a non-Medicare valuation for 0152T based on mammography CAD codes 76082-76083, which you can present to payors to obtain reimbursement.
At the same session, the American Society for Therapeutic Radiation Oncology presented a proposal to revise the descriptor for stereotactic radiation treatment management code 77432 to allow treatment of more areas of the head. For some reason, this code refers to "cerebral" rather than "cranial," meaning it only covers the top part of the brain.
Physicians have been using stereotactic radiation to treat all areas of the brain, says Santa Monica, CA oncologist Michael Steinberg, who presented the proposal on behalf of ASTRO.
Also, radiologists requested clarifications to the guidelines for diagnostic ultrasounds and non-invasive vascular procedures to allow you to report color and spectral Doppler scans.
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