Understanding CT Scan Coding Guidelines

1
(No Transcript)
2
Understanding CT Scan Coding Guidelines

• Basics of CT Scan Coding
• CT scan coding guidelines refer to a set of rules
  and principles used to assign appropriate codes
  to diagnostic imaging procedures performed using
  Computed Tomography (CT) technology. The purpose
  of these guidelines is to ensure accurate and
  consistent coding of CT scans across different
  healthcare settings, including hospitals,
  clinics, and physician offices. The guidelines
  for CT scan coding are primarily outlined in the
  Current Procedural Terminology (CPT) codebook,
  which is published by the American Medical
  Association (AMA). The CPT codebook provides a
  list of codes and descriptions that are used to
  report medical services and procedures, including
  CT scans.
• CT Scan Coding Guidelines
• Here are some of the key CT scan coding
  guidelines to consider
• 1. Identify the Correct CT Scan Code
• The first step in coding a CT scan is to identify
  the correct code that corresponds to the specific
  procedure performed. This requires a thorough
  understanding of the anatomy and pathology
  involved, as well as the

3
Understanding CT Scan Coding Guidelines

• appropriate code descriptors listed in the CPT
  codebook. The correct CT scan code selection
  depends upon various factors like the type of CT
  scan being performed, the body part being imaged,
  the contrast material being used (if any), and
  the reason for the scan. Some key steps to
  identify the correct CT scan code includes
• Determine the type of CT scan being
  performed There are several types of CT scans,
  including contrast-enhanced CT, non-contrast CT,
  and CT angiography (CTA). Knowing the type of CT
  scan being performed is crucial to identifying
  the correct code.
• Identify the body part being imaged CT scans can
  be performed on many different parts of the body,
  such as the head, neck, chest, abdomen, pelvis,
  and extremities. Its essential to know the
  specific body part being imaged to identify the
  correct code.
• Determine the contrast material being
  used Contrast material is sometimes used during
  CT scans to help visualize specific structures
  better. Knowing whether contrast material is
  being used and what type of contrast material is
  being used (e.g., iodine-based or barium-based)
  is important to identify the correct code.
• Determine the reason for the scan CT scans can
  be performed for many different reasons, such as
  diagnosing cancer, detecting internal bleeding,
  or evaluating a suspected bone fracture. Knowing
  the reason for the scan is critical to
  identifying the correct code.

4
Understanding CT Scan Coding Guidelines
Once you have gathered all the necessary
information, you can use the Current Procedural
Terminology (CPT) code book to identify the
correct CT scan code. The CPT codes are updated
annually, so its essential to use the most
recent version of the codebook. Its also
important to note that the codes for CT scans are
often bundled with other services, such as the
interpretation of the scan by a radiologist. Be
sure to review all relevant codes and guidelines
to ensure accurate billing and coding. 2.
Understand the Bundling Rules In CT scan coding,
bundling rules refer to the guidelines that
determine how multiple procedures or services
should be reported and reimbursed when they are
performed during the same encounter or visit.
These rules are intended to ensure that providers
are not overpaid for services that are commonly
performed together and that patients are not
charged excessively for care. The bundling rules
for CT scans are based on the National Correct
Coding Initiative (NCCI), which is a set of
coding policies developed by the Centers for
Medicare and Medicaid Services (CMS). The NCCI
includes a set of edits that identify pairs of
codes that should not be billed together in
certain circumstances. These edits are designed
to prevent overpayment for services that are
considered to be components of a more
comprehensive service.
5
Understanding CT Scan Coding Guidelines
For example, if a patient undergoes a CT scan of
the abdomen and pelvis, the codes for these
procedures may be bundled together if they are
performed during the same encounter. This means
that the provider would only be reimbursed for
one of the procedures, even if both were
performed. However, if the CT scan of the abdomen
and pelvis were performed at separate encounters,
then they could be billed separately. The NCCI
also includes guidelines for when modifiers may
be used to bypass the bundling rules. Modifiers
are additional codes that can be appended to the
primary procedure code to indicate that a service
was performed differently than usual or to
indicate that additional work was performed. Its
important to note that bundling rules can vary
depending on the payer and the specific coding
system being used. Providers should always
consult with the payers coding guidelines to
ensure that they are billing appropriately and
avoiding any potential coding errors or
overpayments. 3. Use Modifiers Appropriately In
CT scan coding, modifiers are used to indicate
specific circumstances that affect the way the
procedure is performed, or the circumstances
under which the service is provided. For provider
reference purposes, we are sharing commonly used
modifiers for CT scans (along with their meaning)
6
Understanding CT Scan Coding Guidelines

• Modifier 26 This modifier is used to indicate
  that the radiologist is providing only the
  professional component of the CT scan service.
  This means that the radiologist is only
  interpreting and reporting the results of the
  scan, and did not perform the scan itself. This
  modifier is typically used when the technical
  component of the scan is performed by a different
  provider, such as a hospital or imaging center.
• Modifier TC This modifier is used to indicate
  that the provider is providing only the technical
  component of the CT scan service. This means that
  the provider is only responsible for the
  equipment, supplies, and personnel necessary to
  perform the scan, and did not interpret or report
  the results of the scan. This modifier is
  typically used when the professional component of
  the scan is performed by a different provider,
  such as a radiologist.
• Modifier 52 This modifier is used to indicate
  that a reduced service was performed, for
  example, if a CT scan was scheduled but was not
  able to be completed due to patient cooperation,
  positioning, or other technical reasons. This
  modifier can also be used when a provider
  performs only a portion of a service, but the
  patient is still billed for the full service.
• Modifier 53 This modifier is used to indicate
  that a service was discontinued due to
  extenuating circumstances, such as a patient
  experiencing a severe allergic reaction during
  the scan. This modifier is used when the service
  was partially completed but could not be finished
  due to circumstances beyond the providers
  control.

7
Understanding CT Scan Coding Guidelines

• Modifier 59 This modifier is used to indicate
  that a separate and distinct service was
  performed during the same encounter. For example,
  if a patient had a CT scan of the chest and then
  also had a CT scan of the abdomen during the same
  visit, the 59 modifier would be added to indicate
  that these were two separate services.
• In general, it is important to use modifiers
  correctly in CT scan coding to ensure that the
  service is billed accurately and appropriately.
  Incorrect use of modifiers can lead to claim
  denials or incorrect reimbursement, which can be
  costly for both the provider and the patient. It
  is also important to stay up-to-date with changes
  to modifier codes and usage guidelines to ensure
  that you are using modifiers correctly.
• 4. Be Aware of the Global Period
• The global period refers to the amount of time
  following a surgical procedure during which all
  related services, including follow-up visits and
  diagnostic tests, are included in the initial
  payment. If a CT scan is performed during the
  global period, it may not be separately billable.
  For CT scans, the global period typically lasts
  for 90 days. During this time, any follow-up
  scans or services that are directly related to
  the original CT scan will not be separately
  reimbursed by insurance companies. Its important
  for patients to be aware of the global period in
  CT scan billing, as it can impact their
  out-of-pocket costs for follow-up care. Patients
  should

8
Understanding CT Scan Coding Guidelines
talk to their healthcare provider or insurance
company to fully understand their coverage and
any potential costs associated with CT scans and
related services. Apart from the above coding
guidelines, its important to remember that
payer-specific coding guidelines may change over
time, you have to stay up-to-date on any changes
and adjust your coding practices accordingly. In
summary, CT scan coding guidelines are important
to ensure accurate and consistent coding of
diagnostic imaging procedures. Healthcare
providers and coders must understand the
appropriate codes, modifiers, bundling rules, and
global periods to ensure proper payment and avoid
denials. In case of any coding assistance needed
in radiology coding, email us at info_at_medicalbill
ersandcoders.com or call us at 888-357-3226.