Download Credentials, Reporting and Billing Matthew J. Budoff, MD, FACC

Credentials, Reporting
and Billing
Matthew J. Budoff, MD, FACC
Associate Professor of Medicine
Division of Cardiology
Harbor-UCLA Medical Center, Torrance CA
BILLING/INSURANCE
• Codes:
– 71275 CT Angiography
– 78473 Wall Motion plus Ejection Fraction
• OR -
– 71270 Thoracic CT w/ and w/o contrast
– 3018 Contrast
– 76375 Additional Cuts, 3-D reconstruction
Most Typical Code
• 71275 COMPUTED TOMOGRAPHIC
ANGIOGRAPHY, CHEST, WITHOUT
CONTRAST MATERIAL(S), FOLLOWED
BY CONTRAST MATERIAL(S) AND
FURTHER SECTIONS, INCLUDING
IMAGE POST-PROCESSING
Current CPT Codes Used For
Cardiac CTA in the US
71275 CTA Chest
71250 CT of thorax, w/o contrast
71260 CT of thorax w/ contrast
71270 CT thorax/ without
contrast followed by with
contrast
71275-22 RN monitoring and
beta blocker administration
76497-Unlisted radiology codes
for CT diagnosis and
intervention
71275-59 RN monitoring
and beta blocker
administration
J3490 Beta blockers
A4646 Contrast
76499 Wall motion (78480)
93040 3 lead ECG
71375 3D reconstruction
76497 Calcium scoring reprt
CTA Heart Codes
www.ama-assn.org/ama/pub/category/3885
0146T CT angiography of coronary
arteries (CCTA) (including native and
anomalous coronary arteries, coronary
bypass grafts), without quantitative
evaluation of coronary calcium
0147T CCTA with quantitative evaluation
of coronary calcium
0148T Cardiac structure and morphology
and CCTA, without quantitative
evaluation of coronary calcium
0149T Cardiac structure and morphology
and CCTA, with quantitative evaluation
of coronary calcium
Coronaries alone
Coronaries & calcium scoring
Coronaries & cardiac morphology
Coronaries, cardiac morphology &
calcium scoring
CTA Heart Codes, con’t
0144T CT, heart, without contrast material,
including image postprocessing and
quantitative evaluation of coronary calcium
0145T CT, heart, without contrast material
followed by contrast material(s) and further
sections, including cardiac gating and 3D
image postprocessing; cardiac structure and
morphology
0150T Cardiac structure and morphology in
congenital heart disease
0151T CT, heart, without contrast material
followed by contrast material(s) and further
sections, including cardiac gating and 3D
image postprocessing; function evaluation
(left and right ventricular function, ejection
fraction, and segmental wall motion)
Calcium scoring only
Cardiac morphology only
Congenital studies, noncoronary
RVEF/ LVEF and wall motion
(add-on)
• 1. The test is never covered for screening, i.e., in the absence of
signs, symptoms or disease.
• 2. The selection of the test should be made within the context of
other testing modalities so that the resulting information facilitates
the management decision, not merely adds a new layer of testing.
• 3. The test may be denied, on post-pay review, as not medically
necessary when used for cardiac evaluation of a patient with
extensive disease where there is a pre-test knowledge of extensive
calcification that would diminish the interpretive value.
• 4. Coverage of this modality for coronary artery assessment is
limited to devices that process thin, high resolution slices. The
multidetector scanner must have at least 16 slices per second
capability. For non-cardiac assessment, the multidetector scan may
capability of less than 16 slices per second.
• 5. The administration of beta blockers and the monitoring of the
patient by a cardiologist during the MDCT are not separately
payable services.
• 6. A physician or qualified non-physician provider must be present
during testing.
Reimbursement
• National policies are not yet in place for T
codes
• Local coverage decisions have been made
favorably for all 50 states for medicare
• Many PPO’s are starting to pay, however
coverage is regional at best right now
• Blue Cross/Blue Shield has the most
restrictive national policy
Future Coverage
• Meetings with Blue Cross/Blue Shield
nationally, along with other payors, are
ongoing at the highest levels of ACC, ACR
and SCCT
• Carotid, Renal and Peripheral CT
Angiography is covered by every payor in
every state
Carotids
Renal Angiograms
Scan Directory