Radiology Coding Alert

CT colonography coding is easy with these expert insightsChanges may be on the horizon for virtual colonoscopies, thanks to an American College of Radiology Imaging Network (ACRIN) trial. And being up-to-date on all of radiology's new technologies -- and covered category III codes -- is up to you.Here's what you need to know about reporting these services now.Separate Screening and Diagnostic CodesCT colonography (virtual colonoscopy or CTC) is an enhanced abdominal CT scan in which computer reconstruction allows radiologists to perform a detailed longitudinal 3D bowel examination for polyps, cancer or other disease. This procedure uses helical computed tomography of the abdomen and pelvis, along with 3D reconstruction, to visualize the colon lumen. 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 Rhonda Townley, CPC, with Association of University Radiologists in Knoxville, Tenn.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). Remember to append 26 if the radiologist only interprets the CT and doesn't meet technical component requirements, such as owning the CT machine and covering staffing costs.Also, note that the procedure includes 3D reconstruction. That means you should not report 3D reconstruction codes 76376-76377 with the CT colonography codes.Strike Reimbursement for 0066T -- for NowMedicare does not cover 0066T, the screening CT colonography code. But CMS periodically revises screening benefits, and many think 0066T coverage 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 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.Plus: The American Cancer Society recently updated its screening guidelines to recognize virtual colonoscopy as a cancer-screening tool (http://www.cancer.org/docroot/PED/content/PED_2_3X_ACS_Cancer_Detection_Guidelines_36.asp#coloncancer).Discover Diagnostic IndicationsYou may have more luck with receiving reimbursement for diagnostic CT colonographies (0067T). Payers often won't cover Category III codes -- designating the procedures as experimental. But if you have your supporting ICD-9 codes and documentation in perfect order, your pocketbook could be in for a pleasant surprise. Here's what to watch for.Typically a patient would have an exam if he has a personal or family history of colon polyps, diverticulosis or [...]