One of the new coding requirements imposed by Medicare for 2016 is that practices attach a billing modifier to CT procedures performed with older CT equipment that does not meet the standards of NEMA XR-29-2013. Medicare’s payment for services billed with the new “CT” modifier will be reduced by 5% of the technical component. Both the Radiology Business Management Association (RBMA) and the American College of Radiology (ACR) have posted blog articles this week about the new requirements.
Medicare’s required changeover to ICD-10 diagnosis coding has shed more light than usual on a topic that requires constant diligence by radiology practices. Regardless of the payer being billed, good procedure coding and diagnosis coding are a must – and the source material for that coding is the documentation found in the radiologist’s report of the imaging examination.
The use of 3D reconstruction along with CT imaging is quite common for many types of exams performed by radiology practices. In some cases it is a minimum requirement in order to bill for the exam that was intended, while in other cases it will garner extra reimbursement. Either way, it must be specifically documented in order for coders to properly bill for the procedures. In this article we will review the financial reasons for providing good documentation, identify when 3D reconstruction is required and when it is an additional charge, and finally understand the documentation requirements that will provide the maximum reimbursement in these various circumstances.