Health Information Management

Q&A: Should we hardcode modifier -CT?

APCs Insider, January 15, 2016

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Q: Our radiology department is requesting that we add a new modifier to their charge description master (CDM), modifier –CT (computed tomography [CT] services furnished using equipment that does not meet each of the attributes of the National Electrical Manufacturers Association [NEMA] XR-29-2013 standard). They want this added to the CT scan line items, but they are not sure if it is for all of the items or only certain ones. Can you provide more information that might help us know how to proceed?
A: Each facility needs to have a discussion before you hardcode the modifier to the CDM. Modifier –CT is a new modifier for 2016 and the NEMA standard has to do with dose optimization and management. For CT scans that are performed on equipment that is non-compliant with this standard, the modifier must be reported on specific codes. The specific CPT codes are listed in Transmittal 3425 and the Medicare Claims Processing Manual, Chapter 4, section 20.6.12.
A discussion is warranted if you have more than one CT scanner in use at your facility. This modifier is only applicable to scanners that don’t meet the requirement, and a payment reduction is involved when the modifier is reported. For CY 2016, CMS instituted a 5% reduction in payment when the modifier is reported, but the percentage increases for CY 2017 and beyond. So, if you have multiple scanners in use, you want to be sure that the modifier is only applied to those services provided on the non-compliant scanner/equipment.


Editor’s note: Denise Williams, RN, CPC-H, seniorvice president of revenue integrity services at Revant Solutions,in Fort Lauderdale, Florida, answered this question.

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