Part B Insider (Multispecialty) Coding Alert

Published on Sat Sep 13, 2003 PDF

CPT editorial panel reputed to be considering new codes

Confused about how to code a virtual colonoscopy? Help is on the way.
 
Virtual colonoscopies are a new twist on existing procedures. "We're doing a standard CT scan of the abdomen with reconstructed images, because we're taking the images that were done in the direct axial plane and reconstructing them into a 3D image or multiplanar image of the body structures, in this case the intestines and colon," says coding expert Jeff Fulkerson in Atlanta.
 
"There are no CPT Codes that currently exist to report virtual colonoscopy," says Scottsdale, Ariz., physician Joel Brill. He says Medicare doesn't cover the procedure now.
 
Association insiders tell PBI that virtual colonoscopy is one topic that's been discussed in recent debates of the CPT editorial panel. One source says the American College of Radiology proposed codes to cover this service last year, and another insider says the proposal is being debated now. The ACR declined to comment.
 
Brill says there are unresolved questions: Will virtual colonoscopy be a radiological procedure alone, or also something a gastrointestinal physician might perform? Does virtual colonoscopy refer simply to CT or MRI imaging procedures, or also capsule endoscopic images and "video pictures without an endoscope"?
 
"This will be something that will be on everybody's radar screen," Brill says.
 
But Fulkerson insists it's possible to bill for a virtual colonoscopy now, by breaking the procedure down into two components: the CT scan (74150) and the reconstructed images (76375). Follow your state's local medical review policy for a CT scan of the abdomen to make sure you get paid, he says. "If there is a diagnostic reason, [and] medical necessity is clearly shown ... then it definitely should be paid for," Fulkerson says.
 
One thing Brill and Fulkerson do agree on: Virtual colonoscopy isn't covered as a screening benefit, nor is it likely to be. Medicare is reluctant to cover any expensive tests in the absence of specific symptoms. A family history of colon problems probably won't hold sway with carriers.