Radiology Coding Alert

Question: How should I code CT cardiac scoring? I bill only for the professional fee.

Ohio Subscriber

Answer: Coding experts disagree on the best way to code cardiac scoring. Because cardiac scoring is a limited computerized axial tomography (CT) of the thorax, some coders recommend using 71250 (Computerized axial tomography, thorax; without contrast material) appended with modifier -52 (Reduced services).

Because this code does not precisely describe cardiac scoring, others, based on the AMA's requirement that services not precisely described by an existing code be reported with an unlisted-procedure (UP) code, recommend reporting 76499 (Unlisted diagnostic radiologic procedure). The AMA also notes that when reporting any UP code, you should submit supporting documentation such as a procedure report with the claim. This documentation should provide a comprehensive description of the nature, extent and need for the procedure, as well as the time, effort and equipment required for the service.

Coding preferences vary among payers, and coders should ask the carrier for its policies. To report only the professional component, append modifier -26 (Professional component) to whichever code you use.

However, the diagnosis code for the study is crucial for reimbursement. Each payer has a list of accepted diagnostic codes that justify cardiac scoring. Most payers do not pay for studies performed as screenings.

You Be the Coder and Reader Questions were answered and reviewed by Donna Richmond, RCC, CPC, radiology coding specialist with Acadiana Computer Systems Inc., a medical billing management company based in Lafayette, La., that serves more than 200 radiologists, pathologists and anesthesiologists.