Radiology Coding Alert

Our experts clear up your myelogram and supervision uncertainty If you code for an independent diagnostic testing facility (IDTF), you know you have special hoops to jump through on the way to reimbursement. Find out what your IDTF needs to do to get paid.
 
Problem: I'm uncertain about the regulations for IDTFs. For example, can an IDTF expect reimbursement from Medicare for a lumbosacral myelogram?
 
Answer: Maybe. Consider the following rules to learn whether your check is in the mail. 1. Make sure you're coding for a diagnostic test
 
Medicare gives the code for a lumbosacral myelogram (CPT 72265 , Myelography, lumbosacral, radiological supervision and interpretation) a 9 in the "Supervision for Diagnostic Test" column of its National Physician Fee Schedule Relative Value File. This 9 means "concept does not apply." But, if you look at the column for 72265-TC (Technical component), the code is 3, personal supervision. Level 3 means the "procedure must be performed under the personal supervision of a physician" in the room during the procedure.
 
"The basic rule is that CMS instructs carriers to pay only for diagnostic tests," says Thomas W. Greeson, JD, an expert in radiology law with Reed Smith LLP in Falls Church, Va. This means "those tests that have a level of supervision assigned by CMS and [that are] identified in the Medicare Physician Fee Schedule list of diagnostic tests, updated annually." So if your IDTF followed that rule, you're one step closer to Medicare reimbursement.
 
You can find the 2005 level of supervision for diagnostic tests at www.cms.hhs.gov/providers/pufdownload/rvudown.asp. 2. Confirm that the test is on your list of Medicare-approved procedures
 
"When an IDTF applies for licensure, the facility provides a list of all the procedures that could be performed. If myelograms were not on the initial application and the facility wants to begin doing them, they can't," says Greg Schnitzer, RN, CPC, CPC-H, CCS-P, manager, coding, compliance and quality assurance at CodeRyte Inc. in Bethesda, Md.
 
If they want Medicare to pay, the IDTF needs to apply for a new license, Schnitzer says. There is more information on this available online at www.hgsa.com/professionals/bguides/idtf-m.html.
 
If you want to see the types of tests you can include, there is a list of acceptable IDTF procedures available at www.hgsa.com/professionals/pdf/mr0900.pdf, Schnitzer says. You'll find acceptable spine and pelvis codes, including myelograms, on page 30.
 
Alternative: The IDTF may perform procedures not on the list, Schnitzer says, but they won't be reimbursed for it by Medicare. He suggests checking with private payers to see if they'll pay. 3. Decide which codes to report Depending on the circumstances, an IDTF may bill for the global myelogram, code 72265, or just the technical component, 72265-TC, Greeson says.
 
Example: [...]