Radiology Coding Alert

Because most insurers offer a three-month grace period before you must begin reporting new CPT Codes, you may not have updated your superbills to reflect the new radiology codes yet. But some carriers have eliminated the grace period - leaving you high and dry for reimbursement for 76085. If your carrier doesn't honor the grace period and requires you to report the new codes effective Jan. 1, study these basics of the new computer-aided detection (CAD) codes to keep the cash flowing into your mammography department. Recognize 76085's Replacements Many carriers have already eliminated 76085 and G0236 from their systems for dates of service after Dec. 31, 2003. Empire Medicare, for example, published a policy that states, "There will be no grace period for CAD code 76085 ; therefore 76085 should not be reported for claims with dates of service on or after Jan. 1, 2004." CPT 2004 introduced the following two CAD add-on codes:   +76082 - 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; diagnostic mammography (list separately in addition to code for primary procedure)     +76083 - ... screening mammography (list separately in addition to code for primary procedure).   These codes replaced the prior add-on mammography codes, as follows:   +76085 - Digitization of film radiographic images with computer analysis for lesion detection and further physician review for interpretation, mammography     G0236 - Digitization of film radiographic images with computer analysis for lesion detection, or computer analysis of digital mammogram for lesion detection, and further physician review for interpretation, diagnostic mammography (list separately in addition to code for primary procedure).   Carriers will still accept 76085 and G0236 for dates of service between Jan. 1, 2002, and Dec. 31, 2003. And if you erroneously submit 2004 claims with 76085 instead of the new CAD codes, you can still resubmit your claim, says Barbara J. Cobuzzi, CPC, CPC-H, MBA, president of Cash Flow Solutions Inc., a Brick, N.J., billing company. "I don't know the rationale for not allowing a grace period," she says, "but you can resubmit with a corrected claim if you send in the wrong codes." Never Report CAD Codes Alone Both 76082 and 76083 are add-on codes, so you should always report them along with the appropriate base mammography code, depending on whether you perform a screening or diagnostic test. You should report the new add-on code 76082 along with the existing mammography codes for a unilateral or bilateral mammogram, 76090 (Mammography; unilateral) or 76091 (... bilateral). In addition, you can report 76082 with the HCPCS codes G0204 (Diagnostic mammography, producing direct digital [...]