Corporate Compliance

Billing CTs

Compliance Monitor, February 23, 2007

Q: Our staff performed an abdominal/pelvis computed tomography (CT). The physician reviewed the study with the radiologist and ordered a lumbar spine CT. Because we have a multislice CT scanner, our staff did not have to physically rescan the lumbar.

Our staff took the raw data, redid the image processing with a multitude of changes, and using different algorithms and reconstruction planes came up with a lumbar spine scan that produced the same images as would a separate scan of the patient. The radiologist dictated a CT lumbar exam. Various people have told me that they charge a lumbar CT in this instance, because the whole exam is redone, which turns it into a separate and different exam with the full number of images-not just a reconstruction of a particular area.

Should we bill this lumbar reprogramming as a separate procedure?

A: No. Do not bill this lumbar reprogramming as a separate procedure as it does not involve a patient, nor does it involve an additional room/work station or set-up. Also, there are negligible labor costs, and the costs re-lated to a few extra sheets of film, etc., are insignificant.

Although many carriers may allow the Part B professional fees for the interpretation of the film, the additional facility time and costs not already covered by the underlying procedure reimbursement are insignificant.

Providers should not bill for a lumbar CT performed on the same day as an abdominal/pelvic CT, because there is no additional work to justify payment. In addition, the CPT Manual specifically does not allow you to bill these two procedures together.

This answer was provided by HCPro's Briefings on APCs.

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