Radiology Coding Alert

Hint: Tip 2 will save you from countless headaches

You've got a few hoops to jump through if you want to collect on Medicare's abdominal aortic aneurysm (AAA) ultrasound screening coverage. Our experts offer some surefire advice on how to bill this service without worries.
 
1. Ask Whether the Patient Is at Risk

Make sure your patient meets the specific qualifications for this one-time exam, says Jill Young, CPC, with Young Medical Consulting in East Lansing, Mich. To receive coverage, the patients must be "at risk," meaning they have a family history of AAA or are men 65 to 75 years of age who have smoked at least 100 cigarettes.

See www.cms.hhs.gov/Transmittals/downloads/R1113CP.pdf for the requirement details.

"The required criteria must be documented in the ultrasound report or be reflected in the patient's medical record," says Rehna Burge, radiology and catheter lab billing analyst for North Oaks Medical Center in Hammond, La. She advises setting up your scheduling system to check for the criteria before scheduling the patient for the exam.

2. Be Sure You Have a Documented Referral

You need to receive a referral from the provider who performed the patient's "Welcome to Medicare" exam, according to CMS. "Only Medicare beneficiaries who receive a referral for the AAA ultrasound screening as part of the Welcome to Medicare physical exam will be covered for the AAA benefit," CMS says.

3. Curb Payment Troubles With ABN
 
Get a signed advance beneficiary notice (ABN) if you can't find out whether your patient actually had the AAA screening before, Burge says.

4. Dig Up Proper Diagnosis
 
Unfortunately, the national coverage determination (NCD) for this procedure doesn't include a list of covered ICD-9 codes, Burge says. Code V81.2 (Special screening for other and unspecified cardiovascular conditions) is one possibility, but Burge points out that other sources may suggest other codes.

5. Eliminate Deductible Collection
 
The Medicare deductible doesn't apply to this service, although standard copayments do.

6. Forget Luck--Remind MDs of AAA Screening
 
Make sure that primary-care physicians performing the Welcome to Medicare exam know to refer patients at risk for AAA to your practice for this screening exam. Three out of four aortic aneurysms are AAAs, and aortic aneurysms account for about 15,000 deaths in the United States every year, CMS says. Catching AAAs early can make a difference in treating them effectively.

7. Get Used to Using HCPCS G Code

When you've met these requirements, you can feel comfortable reporting the AAA screening with G0389 (Ultrasound B-scan and/or real time with image documentation; for abdominal aortic aneurysm [AAA] screening).

Resource: For more information about the AAA screening, read MLN Matters article MM5235 at www.cms.hhs.gov/MLNMattersArticles/downloads/MM5235.pdf.