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Understanding the new codes for cardiac CT

Radiology Administrator's Compliance and Reimbursement Insider, September 1, 2005

By Jackie Miller, RHIA, CPC

The American Medical Association (AMA) has released new Category III CPT® codes for CT and CT angiography (CTA) studies of the heart and coronary arteries.

Note: Category III codes are used to report new technology services that do not yet meet the criteria for inclusion in the main body of CPT.

Although these codes were released July 1, they do not take effect until January 1, 2006. Until that time, current coding guidelines remain in effect.

Read about the new codes in the table below or find them on the AMA Web site at www.ama-assn.org/ama/pub/category/3885.htm/#schedule3.

At this time, coding guidelines have not yet been issued. However, based on the code definitions, the new codes are anticipated to be used as follows.

Code 0144T will be reported for CT/CTA of the heart without contrast. All of the other new codes (0145T-0151T) are for CT/CTA without and with contrast. The without-contrast exam (0144T) also includes calcium scoring.

Report 0150T for evaluation of heart structure and morphology in patients with congenital heart disease. When this exam is performed in patients without congenital heart disease, report 0145T.

Report 0146T for evaluation of the coronary arteries without calcium scoring. For evaluation of the coronary arteries with calcium scoring, report 0147T.

Report 0148T for evaluation of heart structure, morphology, and coronary arteries. If the exam includes calcium scoring, report 0149T instead of 0148T.

Finally, if heart function evaluations such as ejection fraction and wall motion are performed in conjunction with any of the exams described by codes 0145T-0150T, code 0151T should be reported as an add-on code.

The new codes are a result of ongoing controversy over the proper coding for these services. Providers and their billing personnel have had to deal with conflicting and changing advice from payers and professional societies regarding proper code assignment for cardiac CT, coronary CTA, and CT calcium scoring.

The American College of Radiology (ACR) announced earlier this year that coronary CTA should be reported using the unlisted CT code (76497). These studies were previously reported as CTA of the chest (71275). The ACR now recommends that the chest CTA code be reserved for noncardiac studies (e.g., exams performed for pulmonary embolism or aortic dissection).

Cardiac calcium scoring involves quantitative evaluation of the amount of calcium in the patient's coronary arteries. This procedure is often performed for screening purposes on asymptomatic patients. The ACR recommends reporting calcium scoring with the unlisted CT code (76497).

In addition to the cardiac CT codes, there are several other new Category III codes of interest to the radiology community.

Use new code +0152T to report computer-aided detection for chest x-rays (e.g., two-view chest, 71020). Use new codes 0153T and 0154T for services involving aortic pressure sensors inserted at the time of endovascular repair.

Insidersource

Jackie Miller, RHIA, CPC, senior consultant, Coding Strategies, Inc., 5041 Dallas Hwy., Ste. 606, Powder Springs, GA 30127; 770/445-5566; jackie.miller@codingstrategies.com.

Researchers from Seoul National University have found that single photon emission computed tomography (SPECT) is useful in evaluating stem cell therapy with ischemic or coronary heart disease, according to Health Insurance Law Weekly.

"Due to its noninvasiveness and convenience, peripheral stem cell therapy will be widely used in patients with ischemic heart disease," researcher Dong Soo Lee said according to Health Insurance Law Weekly.

"Gated myocardial SPECT will help evaluate treatment effect and suggest the underlying mechanism whereby the damaged heart muscles improve after stem cell infusion," Lee said.

Researchers at Brigham and Women's Hospital in Boston say that although cardiac tumors are rare, they are challenging to diagnose. CT can be a useful diagnostic tool, according to Managed Care Law Weekly.

"New noninvasive CT and magnetic resonance imaging exams are changing the diagnostic approach. Echocardiography and angiocardiography with or without coronary arteriography remain routine methods for evaluating cardiac neoplasms. However, CT provides additional diagnostic information and is regarded as essential for adequate staging and treatment planning, particularly when surgical resection is being considered," researchers said, reported Managed Care Law Weekly .

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