Radiology Coding Alert

Non-Medicare values may prevent your usual Category III headache New computer-aided detection (CAD) technology means new codes that you have to report correctly on your first try. Here’s how to give your 0152T claims their best chance at reimbursement.

Code +0152T (Computer-aided detection [computer algorithm analysis of digital image data for lesion detection] with further physician review for interpretation, with or without digitization of film radiographic images,  chest radiograph[s]) became effective Jan. 1, 2006, less than a year after Riverain Medical introduced the RapidScreen chest x-ray CAD system. You use the code when a radiologist uses the chest x-ray CAD system, typically to detect early-stage lung cancer.

The code is an add-on code, and a note with the descriptor tells you to use 0152T in conjunction with the following codes, says Michael Longacre, a consultant with HealthCare Market Strategies Inc. in Yamhill, Ore.:

• CPT 71010 --Radiologic examination, chest; single view, frontal

• CPT 71020 --Radiologic examination, chest, two views, frontal and lateral

• CPT 71021 --... with apical lordotic procedure

• CPT 71022 --... with oblique projections

• 71030--Radiologic examination, chest, complete, minimum of four views. Access the full Category III details at www.ama-assn.org/ama/pub/category/3113.html.

Remember: An add-on code describes “additional intra-service work associated with the primary procedure,” according to the CPT manual. You must never report an add-on code alone--only report it in addition to the specified primary procedure codes.

Example: The radiologist performs a complete chest radiological exam including at least four views and CAD with further review and digitization of the images. He discovers solid pulmonary nodules.

How to code: Report the x-ray views with 71030 and the CAD with 0152T. Report the solid pulmonary nodules with 518.89 (Other disease of lung, not elsewhere classified), unless the radiologist supplies a more
specific diagnosis. Guide Payer to Non-Medicare Fee Schedule CPT guidelines instruct you that if you have a Category III code, such as 0152T, available, you must report it instead of a Category I unlisted-procedure code.

The AMA creates Category III codes to track whether the service merits its own Category I CPT code. If you never submit the Category III code to Medicare, you’ll likely never have a dedicated code for that service, says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CHBME, president of CRN Healthcare Solutions in Tinton Falls, N.J.

The Medicare Physician Fee Schedule doesn’t carry relative value units (RVUs) for Category III codes, resulting in notoriously poor reimbursement and denials that state the [...]