Part B Insider (Multispecialty) Coding Alert

Published on Thu Jun 16, 2005 PDF

But it's up to carriers to decide how much to reimburse codes

Coronary computed tomographic angiography (CTA) may be on the cutting edge of medical procedures, but the procedure has been left behind by CPT - until now.

The latest batch of Category III CPT codes, released early July, include codes for CTA as well as computed tomography (CT) scans of the heart.

The CTA codes include CTA of coronary arteries without quantitative evaluation of coronary calcium (0146T) and with coronary calcium evaluation (0147T). They also include cardiac structure and morphology and CTA of arteries both without (0148T) and with (0149T) evaluation of coronary calcium.

The new heart CT scan codes include heart CT without contrast (0144T) as well as both with and without contrast (0145T), cardiac structure and morphology in congenital heart disease (0150T) and an add-on code (0151T).

The new CTA codes have "been a long time in coming," says Belinda Inabinet, technical support manager with South Carolina Heart Center in Columbia. Many people are having difficulty obtaining payment for CTAs because different payors recommend either unlisted code 76497, or chest CT code 71275. The new codes will provide consistency, but it's extremely difficult to obtain reimbursement for Category III codes, she notes.

The fact that the CTA codes include codes with and without calcium evaluation makes Inabinet wonder if Medicare will start paying for calcium scoring, which has hardly ever been covered. Most carriers regard calcium scoring as a screening benefit, or else bundled with the CTA. A coronary scan will include soft plaques as well as hard plaques, which are made of calcium, she explains.

Pharmacists Gain New Codes

If your office employs a pharmacist, then he or she will be able to report face-to-face patient assessment and intervention using three new Category III codes. Bill for the first 15 minutes of a pharmacist's medical therapy management services using 0115T and each subsequent encounter using 0116T. You can report each additional 15 minutes using 0117T.

The Pharmacist Services Technical Advisory Coalition in Bethesda, MD requested the new codes, according to a release. "This is a major victory for pharmacists and for patients," said Dan Buffington, PSTAC's representative to the AMA Health Care Professionals Advisory Committee.

The new codes also cover pancreatic islet cell transplantation via percutaneous (0141T), open (0142T) and laparoscopic (0143T) approaches. These codes "include infusion of islet cells with monitoring and management of portal and systemic hemodynamics, monitoring and management of blood glucose and insulin therapy, immunotherapy infusion, antibiotic infusion, analgesic and sedative administration and monitoring, and all other therapeutic injections and infusions administered during the islet infusion," the AMA notes.

The new codes also include two add-on codes, for computer-aided detection for chest radiographs (0152T) and transcatheter placement of wireless physiologic sensor in an aneurismal sac during endovascular repair (0153T). You can also bill for studying the wireless physiologic sensor in the aneurysmic sac using 0154T.

Other new Category III codes released include: