Understanding the new codes for cardiac CT

Nov 20, 2005

The American Medical Association (AMA) has released new Category III Current Procedural Terminology (CPT) codes for CT and CT angiography (CTA) studies of the heart and coronary arteries. 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 will not take effect until January 1, 2006. Until then the current coding guidelines will remain in effect. The new codes can also be found on the AMA Web site.

How to use the new codes

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.

Exams performed with or without contrast

Report code 0150T is for the 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 code 0146T will be used for the evaluation of the coronary arteries without calcium scoring; when this exam is performed in patients for evaluating the coronary arteries with calcium scoring, report 0147T.

Report code 0148T is for the evaluation of heart structure, morphology, and coronary arteries ; if the patient's exam includes calcium scoring, report code 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.

Current coding for heart CT

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 payors 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 a 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).

Other changes

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 (CAD) 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.

By Jackie Miller
AuntMinnie.com contributing writer
November 21, 2005

This article originally appeared in the Radiology Administrator's Compliance & Reimbursement Insider, a monthly newsletter published by HCPro that is designed specifically for radiology administrators.

Miller is a senior consultant with healthcare coding service firm Coding Strategies of Powder Springs, GA.

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