Radiology Coding Alert
Ask Your Payer How You Should Report CT Cardiac Scoring
Tennessee Subscriber
Answer: Electron beam computed tomography (EBCT) is used to determine the amount of calcium in coronary arteries and estimate the risk of associated coronary artery disease. The heart is scanned and a scoring is performed to quantify the amount of coronary artery calcification. Medicare and many other insurers consider this a non-covered service because its greatest value appears to be "screening."
Many carriers and coding experts offer differing advice regarding how you should report this service. Because cardiac scoring is a limited CT of the thorax, some coders recommend using 71250 (Computed tomography, thorax; without contrast material) with modifier -52 (Reduced services) appended.
Code 71250 does not precisely describe cardiac scoring, so other coders, based on the AMA's requirement that you should report an unlisted-procedure code for services not precisely described by another code, recommend reporting 76497 (Unlisted computed tomography procedure [e.g., diagnostic, interventional]).
Some private payers, such as Excellus Blue Cross and Blue Shield (a private insurer in New York), prefer practices to report the temporary non-Medicare HCPCS code S8092 (Electron beam computed tomography [also known as ultrafast CT, cine CT]) instead. You cannot report this code to Medicare carriers.
Ask your insurer for specific written guidance before you report cardiac scoring services, so you can be sure that you're billing it correctly on your first submission.
-- The answers for You Be the Coder and Reader Questions were reviewed by Cindy C. Parman, CPC, CPC-H, RCC; and Gary S. Dorfman, MD, FACR, FSIR.
Radiology Coding Alert
- 4 Answers for Your SPECT Bone Procedure Coding Questions
If you assume that CPT 78306 is bundled into 78320, you could be writing off [...] - Clip and Save Chart:
Know Your Bone-Scan Code Pairs
Use this nuclear-medicine code crosswalk to save time and cut denials
If your practice has [...] - Performing DEXA or Mammo Too Often? Prepare an ABN
Don't write off the $100-$150 that Medicare allots for 76092 and 76075
If you're researching payable [...] - News You Can Use:
Medicare Nearly Doubles Ophthalmic A-Scan Pay
CMS' fee schedule update increases pay for several radiology procedures
If Medicare's 2004 Physician Fee [...] - Coding Update:
Say Farewell to NCCI's CVC Guidance Edit
The edit that bundled 76937 and 75998 was short-lived but caused quite a stir - You Be The Coder:
How Should We Report Knee X-Rays?
Question: We performed an upright weightbearing AP view of both knees, and the coder assigned [...] - Reader Question:
You Can Pair 73580 With 27370
Question: When we perform supervision and interpretation for knee arthrography, can we also report - Reader Question:
Ask the Doctor to Choose Enteroclysis Tube Code
Question: Our radiologist inserted an enteroclysis tube. How should we report this service and the [...] - Reader Question:
Report 76360 for CT Guidance During Biopsy
Question: Our practice performed CT guidance during a liver biopsy. How should we report our [...] - Reader Question:
Ask Your Payer How You Should Report CT Cardiac Scoring
Question: How should we report CT cardiac scoring? We would like to bill for the [...] - Get ABNs, or Risk Picking Up Patient Tabs
Without ABNs, unpaid Medicare bills may become your problem
If you aren't obtaining advance beneficiary notices [...] - ABNs:
What to Change, What to Leave Alone
Got an itch to make a switch on an ABN? Proceed with caution
When it comes [...] - You Be The Expert:
ABNs and Uncovered Medicare Services
Question: Our office obtains advance beneficiary notices each time there is some doubt about whether [...] - Reader Question:
Follow the CMS Definition of 'Deliver'
Question: Since the purpose of an ABN is to inform the patient about a service, [...]
