Cardiovascular Business - May/June 2008 - (Page 8)

“We will analyze whether coronary CTA improves cost, efficiency and safety, but right now we don’t have enough data.” Charles P. O’Brien, MD, president of sanford UsD Medical Center Keeping up with the complex and ever changing rules can be difficult. “I still have people who think they can bill a 71275 [CPT code for chest CT] instead of the proper T code,” Biga says, adding that the T codes have been available for more than two years (see chart on page 7). › Private Practices Must Have the Referrals Before a private practice invests in a CT scanner, it should ensure it will generate enough referrals and have a CT champion onboard, recommends Vance Chunn, CEO of Cardiology Associates, a 28-physician practice in Mobile, Ala. Chunn also acknowledges the importance of knowing the cost, not just of the scanner but of any site construction, added personnel and physician training. The last step is to conduct a proforma that shows the scanner will be profitable, he says. Cardiology Associates was the first private practice group in the U.S. to purchase a GE Healthcare LightSpeed VCT about three years ago. Initially, the group eyed cardiac MRI, but gradually switched to CT as they conducted their research. They’ve had difficulty getting local radiology groups to provide “supplemental” reading of soft tissue, bone and other structures associated with coronary CT angiography imaging. To date, only one local group has accepted their offer, otherwise, the supplemental reading goes to a radiologist in neighboring Louisiana. They bill globally for CTA procedures and pay the radiologists a set fee. The group performs about six to eight coronary CTA exams daily. The scanner also is used to image the head, chest, lower extremities and peripheral vascular territories. The group has found CT imaging to be particularly advantageous in pre- and postoperative electrophysiology and peripheral vascular procedures. Having the right code is the first part of the equation because policies vary on the number of T codes for which they allow billing. The second part of the equation is having the right indication for the test. The indication must match the Medicare local coverage determination (LCD) for your state and/or private payor medical policy. The clinical indications can vary from payor to payor—private or government. Some payors, for example, may allow a CT scan following an indeterminate nuclear stress test, while others may not. The third part of the equation is to have the appropriate diagnoses. “It’s important to read the policy,” Biga says. “It could say that the only diagnosis acceptable for coronary CTA is for the presence of coronary artery disease. Therefore, any claims with ‘chest pain’ as the diagnosis will be denied.” Other examples of variable requirements from state to state include: ■ Technical—Many payors require at least a 64-slice scanner, some require spatial resolution of 1 mm or less. ■ Clinical—Some payors will reimburse for beta blocker administration when billed separately, others are very specific that it cannot be billed separately. ■ Supervisory—Some mandate direct supervision of CT scans by physicians, others are silent about it. ■ Competence—Some require physicians to be credentialed (the American College of Cardiology and the American College of Radiology each have separate requirements for their respective specialties) in order to supervise and interpret the test, others do not specify such a mandate. To make matters even more complicated, the government is integrating the use of Medicare Administrative Contractors (MAC). In Illinois, for example, it’s possible that a provider could have their Medicare part A under one LCD and their Medicare part B under another LCD. If a different insurer wins the MAC integration contract, it would give the provider a third LCD to contend with, Biga says. Another step in the process is going through the various radiology business managers (RBM) that insurance companies hire to vet claims prior to the imaging study. After providers discern whether their carrier covers the indicated coronary 8 Cardiovascular Business May/June 2008

Table of Contents Feed for the Digital Edition of Cardiovascular Business - May/June 2008

Cardiovascular Business - May/June 2008 Contents First Word Cover Story - Coronary CTA: Drafting the Strategic Plan Financing New Technologies: Early Adopters, Lease vs. Purchase, and Joint Ventures Clinical Study Digest: ACE or ARB: It's Your Choice Can Off-Hour D2B Times Be Reduced Without Breaking the Bank? Digital Image Management Primer: Integrating Echo SPECT/CT for Cardiac Disease Detection: An Economic Conundrum Integrating the Healthcare Enterprise Connects IT Systems News & Views Calendar Reader's Resources The Back Page

Cardiovascular Business - May/June 2008

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