Don’t Wait for CPT: Maximize Virtual Colonoscopy Payment Now
Posted on 27. Jan, 2009 by Editor in Hot Coding Topics
Learn whether to file an ABN with 0066T, 0067T.
CMS is set to decide in February whether it will grant national coverage for virtual colonoscopies to screen for colon cancer. But when your gastroenterologist uses the latest technology for diagnostic work — under the right circumstances — you can bill right now for computed tomography colonography.
Some Medicare carriers, such as Palmetto GBA, accept …
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Some Medicare carriers, such as Palmetto GBA, accept category III (temporary) codes 0066T (Computed tomographic [CT] colonography [i.e., virtual colonoscopy]; screening) or 0067T (… diagnostic), as appropriate, for so-called “virtual” colonoscopy, also known as CT colonography (CTC).
Even then, you’ll have to document a failed “instrument colonoscopy” to expect reimbursement for virtual colonoscopy claims.
“CT colonography is only indicated in those patients in whom an instrument colonoscopy of the entire colon is incomplete despite adequate patient preparation, this episode or in past episode(s),” says Palmetto’s policy, or “a history of adverse event with instrument colonoscopy (i.e., perforation), or a clearly documented condition which is incompatible with colonoscopy such as barium enema demonstrating highly tortuous colon, severe strictures, etc.”
“There are some unfortunate patients we come across for whom, due to unique contraindications or other complications, this is their best and only diagnostic tool,” says Debbie Rooth, CPC, LVN, who works for Mission Internal Medical Group in Mission Viejo, Calif. It’s nice to have that much clarity in a local coverage determination, she says; while Palmetto isn’t endorsing wide-spread CTC use, “they’re explaining why, in some rare cases, it is a valid examination.”
Caution: Coverage for 0066T and 0067T is far from universal, with many Medicare carriers holding
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