Radiology Coding Alert

Don't let these temmporary codes leave a hole in your pocket

If you've been struggling to report coronary CT angiography (CCTA) with 76497 (Unlisted computed tomography procedure [e.g., diagnostic, interventional]), there's good news on the horizon. The American Medical Association is offering a number of Category III codes - effective Jan. 1, 2006 - to describe the emerging CCTA technology, a possible step in the direction of permanent CPT Codes . Overcome Category III RVU Deficiency If you have the option of using a Category III code for a procedure, you must use that code instead of a Category I unlisted-procedure code, unless you have specific payer guidance. Snag: Category III codes don't carry relative value units for determining reimbursement, which means your payer could deny payment for these procedures.

You can help your payer ease through the struggle to choose RVUs for Category III codes by directing them to a similar CPT code with established RVUs that reasonably cover your costs, says Marvel Hammer, RN, CPC, CHCO, president of MJH Consulting in Denver. If necessary, check with physicians and product representatives to create an information packet that includes costs and be sure your payer rep gets this information.

Option: Some Medicare Part B carriers (Empire in New York and New Jersey, HGSA in Pennsylvania, and Palmetto GBA in South Carolina) now have Local Coverage Determinations (LCDs) telling you to report CCTA with 71275 (Computed tomographic angiography, chest, without contrast material[s], followed by contrast material[s] and further sections, including image post-processing). This may be a good choice to share with payers deciding on Category III RVUs, but if you're covered by a similar policy, keep an eye out to see if the LCD changes, requiring you to report the Category III code instead or reducing your current reimbursement
for CCTA.

Upside: Taking a hit in reimbursement now could pay off in the long run. "The reason Category III codes exist is to determine whether there is a need to create a CPT code for it. If Medicare never receives submissions of the Category III codes, they will never become Category I CPT codes," says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CHBME, president of Cash Flow Solutions in Brick, NJ.

You can find the full list of Category III codes (announced July 1, 2005, and going into effect Jan. 1, 2006) at www.ama-assn.org/ama/pub/category/3885.html.

Watch for: The new Category III CCTA codes require the physician to interpret whatever pathology is present on the axial 2D source images.