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New Category 1 Codes for Cardiac Computed Tomography
The American Medical Association (AMA) recently released the 2010 CPT codes that will take effect January 1, 2010. There are 4 new Category 1 codes to report cardiac computed tomography and cardiac computed tomography angiography (CCT/CCTA).
The CCT/CCTA code change proposals were initiated jointly by the multispecialty society collaboration led by SCCT. The multispecialty society team included SCCT, the American College of Cardiology (ACC), American College of Radiology (ACR), American Society of Nuclear Cardiology (ASNC) and North American Society of Cardiovascular Imaging (NASCI). This work, done over the course of the last two years and with the approval of the AMA CPT Panel, finalized greatly simplified codes to report CCT/CCTA procedures in 2010. These Category 1 codes represent a significant step forward to achieve broader patient access to this proven technology.
For 2010, CCT professionals will see major changes in coding - see Category I table below. It is also anticipated that Medicare will issue guidance regarding appropriate utilization of the technology. Stay tuned for important educational materials from SCCT.
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For Hospitals:
In the hospital outpatient prospective payment system (HOPPS) proposed rule released this summer, the Centers for Medicare and Medicaid Services (CMS) proposed Ambulatory Payment Classification (APC) groups for 2009 AMA Category III “T� codes and not for the new CPT CCT/CCTA Category I codes as they were not yet released. We anticipate CMS will assign the new CCT/CCTA Category I codes in similar APC groupings when the final HOPPS rule is released in November 2009. Therefore, in 2010, we do not anticipate significant changes for in payment for CCT/CCTA.
We encourage you to start working with your facility now - it is critically important for hospitals to account for the appropriate costs and work when performing these new 2010 codes. Specifically, when establishing charges for the new codes, hospitals should consider the costs of each new procedure code and develop representative charges for the various services. Hospitals should NOT simply crosswalk the Category III “T� code payment rates to the new codes without considering actual costs of these procedures. Any changed 2010 charges billed on the claims by hospitals will ensure CMS captures the appropriate costs in future rate setting. If hospital providers do not update their charge masters for 2010, hospital rates could be jeopardized when CMS develops rates for 2012 (CMS uses two year old data to set hospital technical rates.)
For Physicians and IDTFs:
Society of Cardiovascular Computed Tomography 2400 N. Street, NW • Suite 601 • Washington, DC 20037 800-876-4195 • http://www.scct.org
CMS will not assign the relative value units (RVUs) for the CCT/CCTA codes until the final Medicare Physician Fee Schedule (MPFS) for 2010 is released later this year, typically around November 1. The MPFS utilizes many variables to calculate payment. Due to expected changes in practice expense, malpractice values, and equipment utilization rate assumptions, it is difficult to predict what payment rates will be assigned to the new CCT/CCTA codes. SCCT will alert you to this information as soon as it is published by Medicare. For the CCT/CCTA 2010 new and deleted CPT codes details, see the table below.
Table 2010 Cardiac CTA AMA CPT Code Changes
2010 CPT Code
• 75572
• 75574
Description
Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology (including 3D image postprocessing, assessment of cardiac function, and evaluation of venous structures, if performed)
Computed tomographic angiography, heart, coronary arteries and bypass grafts (when present), with contrast material, including 3D image postprocessing (including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluation of venous structures, if performed)
Comments
Potential Crosswalk codes Replaces 0145T
Potential Crosswalk codes Replaces 0146T-0149T
• 75571
Computed tomography, heart, without contrast
Replaces 0144T
material, with quantitative evaluation of coronary
Do not bill with 75572-4.
calcium
• 75573
Computed tomography, heart, with contrast
Potential Crosswalk codes
material, for evaluation of cardiac structure and
Replaces 0150T
morphology in the setting of congenital heart
disease (including 3D image postprocessing,
assessment of LV cardiac function, RV structure and
function and evaluation of venous structures, if
performed)
CPT only © 2009 American Medical Association. All Rights Reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
CPT is a registered trademark of the American Medical Association
Society of Cardiovascular Computed Tomography 2400 N. Street, NW • Suite 601 • Washington, DC 20037 800-876-4195 • http://www.scct.org
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