Cardiology Coding Alert

The cat's out of the bag for coronary CTA Category lll codes

If you have been relying on 76497 to get paid for coronary CT angiographies (CCTA), that's about to change - beginning Jan. 1, 2006, the American Medical Association will offer up new Category III codes to take its place.

Overcome Category III RVU Deficiency

 One reason for the difficulty many coders have securing reimbursement for coronary CTAs is that Medicare considers these services to be diagnostic tests, not screenings. As a result, your coding for CCTAs varied by carrier, and many required you to use 76497 (Unlisted computed tomography procedure [e.g., diagnostic, interventional]), says Savanna Siens, CPC, CCS-P, a cardiology coder with Northland Cardiology in Kansas City, Mo. But with the introduction of new Category III codes, you've got much more specific coding options.

Important: If you have the option of using a Category III code for a procedure, you must use that code instead of a Category I unlisted-procedure code, unless your carrier specifically states otherwise. Snag: Category III codes don't carry relative value units (RVUs) for determining reimbursement, which means your payer could deny payment for these procedures.

Tip: Help your payers overcome the struggle to choose RVUs for Category III codes by directing them to a similar CPT code with established RVUs that reasonably cover your costs, says Marvel Hammer, RN, CPC, CHCO, president of MJH Consulting in Denver. If necessary, check with physicians and product representatives to create an information packet that includes costs and be sure your payer rep gets this information.

Option: Some Medicare Part B carriers (Empire in New York and New Jersey, HGSA in Pennsylvania, and Palmetto GBA in South Carolina) have local coverage determinations (LCDs) telling you to report CCTA with 71275 (Computed tomographic angiography, chest, without contrast material[s], followed by contrast material[s] and further sections, including image post-processing). This may be a good choice to share with payers deciding on Category III RVUs, but if you're covered by a similar policy, keep an eye out to see if the LCD changes, requiring you to report the Category III code instead or reducing your current reimbursement for coronary CTA.

Upside: Taking a hit in reimbursement now could pay off in the long run. "The reason Category III codes exist is to determine whether there is a need to create a CPT code for it. If Medicare never receives submissions of the Category III codes, they will never become Category I CPT codes," says Barbara J. Cobuzzi, CPC, CPC-H, CHBME, president of CRN Healthcare Solutions in Shrewsbury, N.J.

Keep These New Codes Handy

You can find the full list of Category III codes announced July 1, 2005, and going into effect Jan. 1, 2006, at www.ama-assn.org/ama/pub/category/3885.html.

Watch for: The new Category III Coronary CTA codes require the physician to interpret whatever pathology is present on the axial 2D source images.