Radiology Coding Alert

Question: The provider performs a supplemental reading of a computed tomographic angiography (CTA) of the coronary arteries with and without intravenous contrast. Ordering system-provided history states elevated troponin and exertional dyspnea. The findings and impression yield negative results. The provider states in the report that this interpretation is a supplemental reading in addition to the report interpreted by the cardiologist. Can the provider bill out separately for this report? If so, what codes would I use?

New York Subscriber

Answer: There are two points to address here. First, after determining the correct CPT^® and ICD-10 codes, figuring out whether or not reimbursement is likely. The second point has to do with the circumstances behind the "supplemental" interpretation itself.

In terms of supplemental interpretations, coders must understand that they do not have free rein to submit this claim out separately for the supplemental interpreting provider. In fact, the American College of Radiology (ACR) offers specific guidelines on how to address these scenarios, if and when they arise. The ACR states that, "in such a case (of supplemental interpretations), payers and patients will not pay two interpretation fees nor are there any appropriate CPT^® modifiers to describe a split interpretation of a single diagnostic imaging study."

This means that only the initial interpreting provider may submit the claim for reimbursement. The ACR goes on to explain that the billing physician will then pay a portion of the payment to the supplementary interpreting provider. Whether or not that payment represents a percentage of the total insurance payment, or a fixed preset rate, is to be determined by the billing provider.

The next point to address is in regards to the coding for this procedure. For a CTA of the coronary arteries with and without contrast, you will apply code 75574 (Computed tomographic angiography, heart, coronary arteries and bypass grafts [when present], with contrast material, including 3D image postprocessing [including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluation of venous structures, if performed]). However, you will find that codes R06.09 (Other forms of dyspnea) and R79.89 (Other specified abnormal findings of blood chemistry) do not match up with 75574 in the code's coding crosswalk. Unless your Local Coverage Determinations (LCDs) state otherwise, this procedure will likely not be paid with those diagnoses attached. Therefore, it is suggested that you send the claim back to the provider to determine if another diagnosis may be warranted.