Radiology Coding Alert

Question: How should we report CT cardiac scoring? We would like to bill for the professional fee.

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.