Part B Insider (Multispecialty) Coding Alert

Published on Fri Nov 02, 2007 PDF

You can have your say during the comment period ending Dec. 14

Your new CT equipment may be a time-saver and a diagnosis dream, but if Medicare has its way, you may be using it a lot less.

In an effort to -curb waste,- the Centers for Medicare & Medicard Services (CMS) recently proposed a set of imaging efficiency measures that would help the Medicare program determine whether certain radiology procedures are necessary.

According to MedPAC, -diagnostic imaging is the fastest growing segment of Medicare spending on physicians- services,- growing twice as fast as other physician services between 1999 and 2003.

CMS and its contractor L&M Policy Research Inc. are seeking comments on the four measures that it introduced, as follows:
 
1. Lumbar MRIs

CMS notes that many lumbar spine problems (such as herniated disks) can often be resolved with conservative therapies, so it will evaluate how many MRIs are performed for patients with low back pain without first trying conservative therapy.
 
2. Mammography Callbacks

CMS has pinpointed abnormally high rates of callbacks for screening mammograms. The high callback rate indicates to CMS that many radiology facilities lack on-site interpreters to provide real-time reviews of the initial studies, or that the reader is unable to determine whether additional imaging is necessary.

CMS plans to compare the number of claims submitted with diagnostic codes to the total number of mammogram codes to determine whether quality or coding issues exist.

But if CMS plans to someday make mammography clinics perform real-time interpretations on every mammogram, imaging centers may not have the manpower required.

-I think that it would not be feasible to look at every screening exam prior to letting a patient leave, especially since the radiologists are performing biopsies and aspirations, and are also looking at ultrasounds and diagnostic mammograms,- says Kim French, CIC, of Crouse Radiology Associates in Syracuse, N.Y. Staffing radiology centers with additional radiologists to read every screening mammogram in real-time would be cost-prohibitive, she says.

3. CT Scans for Abdominal/ Urinary Problems

The study notes that abdominal CT scans for problems such as hydro-nephrosis, kidney/ureter calculi, renal colic and unspecified abdominal pain may not require contrast, although many practices bill for these scans without contrast, followed by a -with contrast- scan. CMS will review these claims to determine when -with contrast- studies are necessary.

-I think they-re correct that in patients who you believe have stone disease (such as renal colic or kidney and ureter calculi), you can perform an unenhanced CT scan along with a KUB [kidney/ureter/bladder x-ray] and you probably don't need the contrast to help make those diagnoses,- says Michael Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York Health Science Center in Stony Brook. -But I would usually do a contrast study on a patient with hydronephrosis so I could review the film later on to see where the dye is being held up. I would also prefer to use a -without followed by with contrast- study on a patient with unspecified abdominal pain, particularly if we suspect a renal mass.-

Possible rationale: When a patient presents with abdominal pain, the physician may perform the contrast study to check for a suspected mass. If the scan shows up positive for a mass, the insurer probably would have no problem reimbursing the practice for the contrast scan. But if the urologist doesn't find a mass and the practice submits the claim with an unspecified abdominal pain diagnosis code, Medicare might think the scan was unnecessary.
 
4. CT Studies of the Thorax

CMS will also evaluate whether thorax CT studies require contrast, either alone or following a scan without contrast.

To read more about the study or to submit comments before the Dec. 14 deadline, go online to the website www.imagingmeasures.com.