Radiology Coding Alert

Question: How can we get Medicare to reimburse a computed tomography angiogram (CTA) of the chest? We report the signs and symptoms with ICD-9 V71.89 , but unless the patient actually has a pulmonary embolism, our carrier won't pay.

Tennessee Subscriber

Answer: It depends on your primary diagnosis code. If your patient's signs and symptoms don't match any of those listed on your carrier's policy, V71.89 (Observation and evaluation for other specified suspected conditions; other specified suspected conditions) won't help you. And, if your carrier only reimburses chest CTAs (71275, Computed tomographic angiography, chest, without contrast material[s], followed by contrast material[s] and further sections, including image post-processing) for embolisms, you will not succeed in reporting any other signs, symptoms or diagnoses.

If you performed the chest CTA to diagnose coronary artery disease, don't count on collecting reimbursement. According to CIGNA's policy (a Tennessee Part B carrier), "Increasing media attention and utilization have recently been given to computed tomography (CT) scans of the chest to assess for coronary artery disease. This technology is commonly known as Ultrafast CT scans ... Statutorily, Medicare does not cover screening for coronary artery disease. If the beneficiary is asymptomatic, the test would be considered screening or routine. If the beneficiary is symptomatic, other testing is considered more appropriate and definitive ..."

CIGNA and many other carriers may consider some chest CTA scans for coronary artery disease on a per-claim basis, but these insurers rarely pay for them. You would have to demonstrate that you first performed other tests to assess coronary artery disease and that the CTA was also medically necessary. However, this  should be a rare exception rather than a rule.

CIGNA's policy states, "In these rare situations, CIGNA Medicare will adjudicate claims on a case-by- case basis, and providers should bill for this service using an unlisted code" (76497, Unlisted computed tomography procedure [e.g., diagnostic, interventional]). The policy states, "Billing for Ultrafast CT of chest to assess for coronary artery disease using CPT Codes other than an unlisted code is considered a misrepresentation of the service actually provided."