Credentials, Reporting and Billing

1. Credentials, Reporting and Billing Matthew J. Budoff, MD, FACC Associate Professor of Medicine Division of Cardiology Harbor-UCLA Medical Center, Torrance CA

2. 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

3. Most Typical Code • 71275 COMPUTED TOMOGRAPHIC ANGIOGRAPHY, CHEST, WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS, INCLUDING IMAGE POST-PROCESSING

4. 71275 CTA Chest 71250 CT of thorax, w/o contrast 71260 CT of thorax w/ contrast 71270 CT thorax/ without contrast followed by with contrast 71275-22 RN monitoring and beta blocker administration 76497-Unlisted radiology codes for CT diagnosis and intervention 71275-59 RN monitoring and beta blocker administration J3490 Beta blockers A4646 Contrast 76499 Wall motion (78480) 93040 3 lead ECG 71375 3D reconstruction 76497 Calcium scoring reprt Current CPT Codes Used For Cardiac CTA in the US

5. 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 CTA Heart Codes www.ama-assn.org/ama/pub/category/3885 Coronaries alone Coronaries & calcium scoring Coronaries & cardiac morphology Coronaries, cardiac morphology & calcium scoring

6. 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) CTA Heart Codes, con’t

7. 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.

8. 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

9. 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

10. Carotids

11. Renal Angiograms

12. Scan Directory