Radiology Coding Alert

Question: We have begun performing CT lung screening procedures because of an affiliation with the International Early Lung Cancer Action Program, which emphasizes this promising CT-based regimen for early diagnosis of lung cancer. However, none of our insurers will pay for these studies. What can we do to get paid for these services?

Arizona Subscriber  
Answer: CT lung screening has received a great deal of publicity, and more patients are asking for these assessments. The studies are similar to regular diagnostic CT scans (e.g., 71250, computerized axial tomography, thorax; without contrast material), although they are often viewed as limited exams because fewer cross-section images are made. Because they are categorized as screening, Medicare and commercial payers will not pay for them.
 
Coding experts note that there are only two ways to get paid: to participate in an academic research program that will fund the screening exams, or to ask the patients to pay for the study. Some radiology practices report they charge $150-$200 for this screening, which represents a big discount from a standard CT.
 
Some practices bill the insurer to get a denial so they can then charge the patient. However, professional coders strongly advise against this strategy because most carriers will deny the claim as "not medically necessary," which precludes the practice from billing the patient. Instead, practices should collect the money up-front and not bill payers. If the patients want to attempt to get reimburse-ment, they should be instructed to submit the bill themselves, but only after they have paid the practice.