Radiology Coding Alert

Question: I've heard about imaging centers getting in trouble for supposedly billing EBCT incorrectly. How should I report these tests? California Subscriber Answer: Many payers will point you to Category III codes 0144T-0151T for these services. Physicians typically use electron beam computed tomography (EBCT), or ultrafast CT, to determine the amount of calcium in coronary arteries and estimate the patient's coronary artery disease risk. You should report calcium scoring alone with 0144T (Computed tomography, heart, without contrast material, including image postprocessing and quantitative evaluation of coronary calcium). Problem: Most payers regard calcium scoring as a screening service and will not cover it. The most commonly covered service is exam of the coronary arteries without calcium scoring, reported with 0146T (Computed tomography, heart, without contrast material followed by contrast material[s] and further sections, including cardiac gating and 3D image postprocessing; computed tomographic angiography of coronary arteries [including native and anomalous coronary arteries, coronary bypass grafts], without quantitative evaluation of coronary calcium). The lowdown: One payer has demanded nearly $100,000 in back payments from a California imaging center that billed EBCT services as x-ray services from November 2004 to December 2005. The imaging center argues that EBCT technically uses x-ray beams. But the payer says it does not cover EBCT services. The imaging center is contesting. Don't miss: Codes 0144T-0151T were not available for use during the period in question. Experts typically recommended using an unlisted CT service code or reduced thorax CT service code for calcium scoring at the time. Bottom line: Check your payer's published coverage policies to know for sure which codes you should report for EBCT.