Radiology Coding Alert

Non-Medicare values may prevent your usual Category III headache

New computer-aided detection (CAD) technology means new codes that you have to report correctly on your first try. Here’s how to give your 0152T claims their best chance at reimbursement.

Code +0152T (Computer-aided detection [computer algorithm analysis of digital image data for lesion detection] with further physician review for interpretation, with or without digitization of film radiographic images,  chest radiograph[s]) became effective Jan. 1, 2006, less than a year after Riverain Medical introduced the RapidScreen chest x-ray CAD system. You use the code when a radiologist uses the chest x-ray CAD system, typically to detect early-stage lung cancer.

The code is an add-on code, and a note with the descriptor tells you to use 0152T in conjunction with the following codes, says Michael Longacre, a consultant with HealthCare Market Strategies Inc. in Yamhill, Ore.:

• CPT 71010 --Radiologic examination, chest; single view, frontal

• CPT 71020 --Radiologic examination, chest, two views, frontal and lateral

• CPT 71021 --... with apical lordotic procedure

• CPT 71022 --... with oblique projections

• 71030--Radiologic examination, chest, complete, minimum of four views.

Access the full Category III details at www.ama-assn.org/ama/pub/category/3113.html.

Remember: An add-on code describes “additional intra-service work associated with the primary procedure,” according to the CPT manual. You must never report an add-on code alone--only report it in addition to the specified primary procedure codes.

Example: The radiologist performs a complete chest radiological exam including at least four views and CAD with further review and digitization of the images. He discovers solid pulmonary nodules.

How to code: Report the x-ray views with 71030 and the CAD with 0152T. Report the solid pulmonary nodules with 518.89 (Other disease of lung, not elsewhere classified), unless the radiologist supplies a more
specific diagnosis.

Guide Payer to Non-Medicare Fee Schedule

CPT guidelines instruct you that if you have a Category III code, such as 0152T, available, you must report it instead of a Category I unlisted-procedure code.

The AMA creates Category III codes to track whether the service merits its own Category I CPT code. If you never submit the Category III code to Medicare, you’ll likely never have a dedicated code for that service, says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CHBME, president of CRN Healthcare Solutions in Tinton Falls, N.J.

The Medicare Physician Fee Schedule doesn’t carry relative value units (RVUs) for Category III codes, resulting in notoriously poor reimbursement and denials that state the services are experimental.

The usual plan of attack is to point out the reimbursement assigned to similar services, says Marvel Hammer, RN, CPC, CHCO, president of MJH Consulting in Denver.

Presenting this information is one of the most difficult parts of the coding process, says Brenda Dombkowski, CPC, a compliance auditor with Yale University medical center in New Haven, Conn.

Better option: Code 0152T is the first radiological Category III code to have a published, suggested non-Medicare fee schedule, says Longacre, whose company facilitates the development and publication of non-Medicare values. 

The 0152T values are largely based on the values for mammography CAD, because the work effort is similar, Longacre says.

Mammography CAD codes include +76082 (Computer-aided detection [computer algorithm analysis
of digital image data for lesion detection] with further physician review for interpretation, with or without digitization of film radiographic images; diagnostic mammography [list separately in addition to code for primary procedure]) and +76083 (... screening mammography [list separately in addition to code for primary procedure]).

Note: Although the non-Medicare RVUs in no way guarantee reimbursement, you can use the RVUs to set your fees and start negotiations with payers, says Jackie Miller, RHIA, CPC, senior consultant for Coding Strategies Inc. in Powder Springs, Ga.

Your best bet may be to present the information to your payers--before providing the service--to negotiate the fee.

Watch Out for Future Applications

Code 0152T is specific to chest x-rays, not a disease, Longacre says.

Though you’re most likely to use it for cancer detection at the moment, the code is broad enough that you may be reporting 0152T in the future for detection of tuberculosis (ICD-9 codes 010-018), pneumothorax (typically 512.x), or other chest diseases, he says.

You may also see additional codes for different technologies, such as CTs or MRIs.

In fact, the AMA released code +0159T (Computer-aided detection, including computer algorithm analysis of MRI image data for lesion detection/characterization, pharmacokinetic analysis, with further physician review for interpretation, breast MRI) Jan. 1, 2006, for implementation July 1.

You’ll report this code for CAD performed in conjunction with 76093 (Magnetic resonance imaging, breast, without and/or with contrast material[s]; unilateral) and 76094 (… bilateral).