Radiology Coding Alert

Because most insurers offer a three-month grace period before you must begin reporting new CPT Codes, you may not have updated your superbills to reflect the new radiology codes yet. But some carriers have eliminated the grace period - leaving you high and dry for reimbursement for 76085.

If your carrier doesn't honor the grace period and requires you to report the new codes effective Jan. 1, study these basics of the new computer-aided detection (CAD) codes to keep the cash flowing into your mammography department.

Recognize 76085's Replacements

Many carriers have already eliminated 76085 and G0236 from their systems for dates of service after Dec. 31, 2003. Empire Medicare, for example, published a policy that states, "There will be no grace period for CAD code 76085 ; therefore 76085 should not be reported for claims with dates of service on or after Jan. 1, 2004."

CPT 2004 introduced the following two CAD add-on codes:

+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)

+76083 - ... screening mammography (list separately in addition to code for primary procedure).

These codes replaced the prior add-on mammography codes, as follows:

+76085 - Digitization of film radiographic images with computer analysis for lesion detection and further physician review for interpretation, mammography

G0236 - Digitization of film radiographic images with computer analysis for lesion detection, or computer analysis of digital mammogram for lesion detection, and further physician review for interpretation, diagnostic mammography (list separately in addition to code for primary procedure).

Carriers will still accept 76085 and G0236 for dates of service between Jan. 1, 2002, and Dec. 31, 2003. And if you erroneously submit 2004 claims with 76085 instead of the new CAD codes, you can still resubmit your claim, says Barbara J. Cobuzzi, CPC, CPC-H, MBA, president of Cash Flow Solutions Inc., a Brick, N.J., billing company. "I don't know the rationale for not allowing a grace period," she says, "but you can resubmit with a corrected claim if you send in the wrong codes."

Never Report CAD Codes Alone

Both 76082 and 76083 are add-on codes, so you should always report them along with the appropriate base mammography code, depending on whether you perform a screening or diagnostic test.

You should report the new add-on code 76082 along with the existing mammography codes for a unilateral or bilateral mammogram, 76090 (Mammography; unilateral) or 76091 (... bilateral).

In addition, you can report 76082 with the HCPCS codes G0204 (Diagnostic mammography, producing direct digital image, bilateral, all views) and G0206 (Diagnostic mammography, producing direct digital image, unilateral, all views).

If you perform a screening mammogram with CAD analysis, you should report 76083 along with either 76092 (Screening mammography, bilateral [two view film study of each breast]) or the HCPCS code G0202 (Screening mammography, producing direct digital image, bilateral all views).

Document Physician Review

The most interesting change from the old code 76085 to the new add-on codes is the addition of the phrase "with further physician review for interpretation" in the descriptors. Although many carriers have published policies requiring radiologists to report the new codes 76082 and 76083 as of Jan.1, insurers have been somewhat vague regarding the physician review requirement.

Here's why carriers require further physician review:

During digital mammography, the radiologist acquires  images using low-dose radiation and maintains the resulting images in a computerized format. Radiologists can also digitize traditional mammography films, but they primarily perform this to store images, rather than as an additional clinical review.

In contrast, radiologists use CAD imaging as an adjunct to conventional mammography (traditional films or digital images), if they identify potential areas of concern that require further workup.

" 'Further physician review' refers to a physician actually reviewing the CAD images and documenting what they find in the images, as opposed to sending the original films through the CAD machine and simply letting the computer flag any 'hot spot,' " says Tammy McMillan, RCC, coder and reimbursement specialist at Radiology Associates PA in Little Rock, Ark.

"Depending on what the verbiage may be in any new LMRPs, I believe the review needs to be documented much in the same way a CT or MR without and with contrast would be documented," McMillan says. "For example, 'CAD analysis highlighted an area on the right breast ... Review of CAD images shows this to be benign findings that correlate with film images.' "

During standard mammography, the physician interprets the films after processing them through the image scanning equipment. This interpretation serves as the documentation of medical necessity for further CAD analysis, after which the radiologist should perform a "further physician review" by adding a paragraph or so in the report.

The complete report, therefore, should include a standard mammography interpretation, followed by a paragraph that indicates what warranted the CAD/digitization, along with an interpretation of the digitization.