Radiology Coding Alert

Question: How should I report a diagnostic virtual colonoscopy on a patient with colon disease? Washington Subscriber
Answer: The appropriate code for this procedure is 0067T (Computed tomographic colonography [i.e., virtual colonoscopy]; diagnostic). Be sure to tie 0067T to the appropriate diagnosis code for the patient, such as 578.1 (Blood in stool). Currently, payers won't cover routine screening CT colonography but may consider it medically necessary when conventional colonoscopy fails for patients with colon disease signs and symptoms. The payer may also want to see evidence that the colonography is likely to affect patient management. Smart move: Keep documentation of the virtual colonoscopy and the failed colonoscopy handy in case payers ask for it. Don't forget: If you aren't sure Medicare will cover the test, make sure to get an advance beneficiary notice (ABN) on file. The ABN instructs the patient that you suspect Medicare won't pay for the service, and the patient must choose whether he is willing to receive the service knowing he may have to pay. The ABN should include an estimate of the cost, and you should have the patient sign and date the document. You should append modifier GA (Waiver of liability statement on file) to 0067T to alert the payer that you have the ABN.

Experts warn: Don't obtain "blanket" ABN forms from all or most of your patients. You should obtain ABNs only when your practice has ample reason to believe that Medicare will deny the claim.