Health Information Management

Q/A: Reimbursement for composite CPT codes

APCs Insider, April 15, 2011

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Q: We’ve been reporting the new combination CPT® code for a CT of the abdomen and pelvis and have found that our reimbursement differs from last year. How does this new code affect the composite APCs for CT scans?

A: Because these studies are in the same imaging family, reporting a CT of the pelvis (CPT® codes 72192, 72193, 72194) and a CT of the abdomen (CPT codes 74150, 74160, 74170) in 2010 triggered a multiple imaging procedure composite APC.

For CY 2011, combination codes (CPT codes 74176, 74177, 74178) denote these services and, coders report a single code when these services are provided at the same session. As a result, the composite is not triggered. A CT scan performed with another exam in the same family, such as a CT of the chest, will trigger the appropriate composite APC. 

Editor’s note: Andrea Clark, RHIA, CCS, CPCH, president of Health Revenue Assurance Associates, Inc., in Plantation, FL, answered this question.



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