j.jacr.2011.02.008
EZEQUIEL SILVA III, MD
INTRODUCTION
CT of the abdomen and pelvis (A/P) when performed together will now be reported with a single code rather than two separate codes. The creation of the combined CT A/P code has led to immediate decreases in professional, technical, and hospital payments compared with the sum of the payment for the individual codes. In this column, I take the reader through a case study demonstrating how a service as valuable as CT A/P could be subjected to such across-the-board cuts, addressing questions that may be on radiologists' minds. For each question, I provide a brief background, describe the ACR's actions, and then describe the result. I also briefly discuss the broader effects of this bundling trend.
What We Did
The ACR asserted that creating a new code combination could have unexpected and undesired consequences. Specifically, the ACR argued that individual codes allowed a requisite level of granularity in reporting combinations of non-contrast-enhanced and contrast-enhanced CT A/P. We further raised concerns for potential abuse and ra-diation risk if providers separated and performed the individual abdominal and pelvic studies on dif-ferent days.
The Result
CMS mandate for new codes super-seded the ACR's expressed con-cerns, and action was required. Had the ACR ignored the CMS mandate for a new code, CMS could have created its own CT A/P codes with an uncertain coding structure and valuation.