Credentials, Reporting Credentials, Reporting and Billingand Billing

Matthew J. Budoff, MD, FACCMatthew J. Budoff, MD, FACC

Associate Professor of MedicineAssociate Professor of Medicine

Division of CardiologyDivision of CardiologyHarbor-UCLA Medical Center, Torrance CAHarbor-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 Chest71250 CT of thorax, w/o contrast71260 CT of thorax w/ contrast71270 CT thorax/ without contrast

followed by with contrast 71275-22 RN monitoring and beta

blocker administration76497-Unlisted radiology codes for

CT diagnosis and intervention

71275-59 RN monitoring and beta blocker administration

J3490 Beta blockersA4646 Contrast76499 Wall motion (78480)93040 3 lead ECG71375 3D reconstruction76497 Calcium scoring reprt

CTA Heart Codes

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

www.ama-assn.org/ama/pub/category/3885

CTA Heart Codes, con’t

Calcium scoring only

Cardiac morphology only

Congenital studies, non-coronary

RVEF/ LVEF and wall motion (add-on)

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)

• 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