News New Category III Codes Now in Effect The updated Current Procedural Terminology (CPT) Category III codes released by the American Medical Association this past July will go into effect on Jan. 1. The seven codes plus one add-on (codes 0144T-1051T) address computed tomography (CT) and are designed to facilitate data collection and assessment in order to help validate the widespread usage of new technologies, services, and procedures. The new codes were developed to address the vast differences between the CT techniques for high-quality CCTA and the examinations described by 71275 – CTA of the thorax. CPT codes and reimbursement for CTA of the thorax was originally developed and valued for imaging of non-cardiac structures within the chest cavity. It was not valued to evaluate the coronary arteries, calcium scoring, structure or function of the heart. The performance of CCTA differs significantly from CTA of the thorax in regard to physician and technical work involving patient preparation and monitoring, scanning protocols, data acquisition, software used, post-processing analysis and interpretation. When To Use The New Codes Unless specific payers have instructed otherwise, the new Category III codes (see table) should be used to report coronary CTA studies since they most accurately describe the procedures performed (AMA CPT® 2006 Guide). A CPT code that merely approximates the service provided is inappropriate. At any given patient encounter, only one of the primary codes (0144T-0150T) is used to describe the services performed. When cardiac function evaluation (ventricular function, ejection fraction and wall motion) is performed, it is reported as an add-on procedure (+0151T) in conjunction with one of the primary procedures (0145T-0150T) and is never reported as a stand alone procedure. Code 0144T is used only when a calcium score is ordered, or when such a scout volume of calcium score prior to coronary CCTA precludes further imaging. When calcium scoring is performed in addition to one of the other cardiac CT and CTA procedures, it is not separately reported, as this service is included in the pertinent procedure codes (0147T or 0149T). Codes 0145T, 0148T and 0149T specify “structure and morphology” in the descriptor, these codes are specific to a pre-electrophysiology CT study. Reimbursement Clarification There is a distinction between CPT codes and reimbursement which is not generally understood. Only Category I codes are valued by the Relative Value Update Committee. While Category III codes are NOT referred to the AMA Relative Value Update Committee for valuation, they can be carrier or payer priced if the service is covered under the specific policy. The ACC is working collaboratively with a number of payers to educate them on the emerging clinical role of this new technology. Category III Codes CPT Code 0144T Long Descriptor Computed tomography, heart, without contrast material, including image post-processing and quantitative evaluation of coronary calcium. (Do not report in conjunction with 0147T and 0149T) Short Descriptor Calcium scoring CPT Code 0145T Long Descriptor Computed tomography, heart, without contrast material followed by contrast material(s) and further sections, including cardiac gating and 3D image post processing; cardiac structure and morphology (For cardiac structure and morphology in congenital heart disease, use 0150T). Note that each code that specifies “structure and morphology” is specific to a pre-electrophysiology CT study, either an ablation in which the atria and pulmonary veins are being evaluated by CT or cardiac resynchronization therapy in which the cardiac venous system is being characterized by CT in anticipation of biventricular pacemaker placement. Short Descriptor Cardiac morphology only CPT Code 0146T Long Descriptor Computed tomography, heart, without contrast material followed by contrast material(s) and further sections, including cardiac gating and 3D image post processing; computed tomographic angiography of coronary arteries (including native and anomalous coronary arteries, coronary bypass grafts), without quantitative evaluation of coronary calcium Short Descriptor Coronaries alone CPT Code 0147T Long Descriptor Computed tomography, heart, without contrast material followed by contrast material(s) and further sections, including cardiac gating and 3D image post processing; computed tomographic angiography of coronary arteries (including native and anomalous coronary arteries, coronary bypass grafts), with quantitative evaluation of coronary calcium (Do not report in conjunction with 0144T) Short Descriptor Coronaries and calcium scoring CPT Code 0148T Long Descriptor Computed tomography, heart, without contrast material followed by contrast material(s) and further sections, including cardiac gating and 3D image post processing; cardiac structure and morphology and computed tomographic angiography of coronary arteries (including native and anomalous coronary arteries, coronary bypass grafts), without quantitative evaluation of coronary calcium. Note as in 0145T, structure and morphology refers to the evaluation prior to a electrophysiologic procedure, in this case of the coronary venous system. Short Descriptor Coronaries and cardiac morphology CPT Code 0149T Long Descriptor Computed tomography, heart, without contrast material followed by contrast material(s) and further sections, including cardiac gating and 3D image post processing; cardiac structure and morphology and computed tomographic angiography of coronary arteries (including native and anomalous coronary arteries, coronary bypass grafts), with quantitative evaluation of coronary calcium. (Do not report in conjunction with 0144T) Again, as in 0145T and 0148T, structure and morphology refers to that of the coronary venous system. Short Descriptor Coronaries, cardiac morphology and calcium scoring CPT Code 0150T Long Descriptor Computed tomography, heart, without contrast material followed by contrast material(s) and further sections, including cardiac gating and 3D image post processing; cardiac structure and morphology in congenital heart disease Short Descriptor Congenital studies, non-coronary CPT Code +0151T Long Descriptor Computed tomography, heart, without contrast material followed by contrast material(s) and further sections, including cardiac gating and 3D image post processing; function evaluation (left and right ventricular function, ejection fraction and segmental wall motion) Short Descriptor RVEF/LVEF and wall motion (add on code)