Report from SCCT: Cardiac imagers need to hone reimbursement strategies

To get reasonable reimbursement for cardiac CT, imagers need to collaborate, put sound data together, train staff to bill properly, and prepare to fight proposed Medicare reimbursement cuts for 2008.

That was the message delivered at the 2007 Society of Cardiovascular Computed Tomography meeting by Dr. Kim Alan Williams, chief of cardiology and nuclear medicine at the University of Chicago.

Intersociety collaboration will be key to addressing impending political challenges for cardiac CT, he said. The societies have shown that collaboration is possible. The American College of Cardiology, American College of Radiology, Society for Cardiac Magnetic Resonance, American Society of Nuclear Cardiology, and SCCT have worked together with varying degrees of commitment to establish training and appropriateness criteria guidelines for the practice of cardiac CT. Collective efforts by the ACC, ACR, and others helped orchestrate the rapid state-by-state acceptance of cardiac CT by private insurers, despite unanswered questions about its clinical efficacy.

"We were able to work on appropriateness criteria together with most organizations to make sure we receive proper compensation from payers and that we get the right test to the right patients," he said. "But we can do a better job making sure we do the appropriate thing with CTA or routine coronary calcium screening."

The Deficit Reduction Act sent shock waves through healthcare, and imagers on all fronts are still trying to influence the policy, according to Williams. A proposed rule from the Centers for Medicare and Medicare Services for an across-the-board 9.9% cut in professional fees for 2008 now poses another formidable challenge. Some estimates project 2007 reimbursement reductions for CTA alone at almost 40% (see "2007 reimbursement guide: What you need to know," Diagnostic Imaging, Dec. 2006).

"That is why it is important for everybody to submit accurate data to Medicare," Williams said.

Eight CPT Category III "T" codes will define reimbursement for next year (CPT 0144T-0150T plus the add-on CPT 0151T). Physicians can use them to report cardiac CT and CTA in areas ranging from coronary artery calcification to cardiac function. Some confusion remains about the nature of these codes, however. Physicians and administrators must submit the right code information along with an additional report with their claims detailing the procedure, patients receiving it, and their indications.

"I can't emphasize that enough. We all have to be very careful to bill these properly. Work with your billing people on how they are going to submit these codes," Williams said.

The next step is to accumulate sufficient outcome data to convince CMS about the clinical value of cardiac CT and obtain CPT Category I codes, according to Williams. Clinical efficacy needs to be well established and services performed at multiple locations across the country. Some organizations like the ACC are putting together a national registry for these data. It will not be ready for some time but will help educate payers.

In the meantime, interested parties have until midnight July 13 to submit comments to CMS about the value of cardiac CT and CTA.

"You can't get around the clinical outcomes when you are invited to argue with the government. The data really make the difference," Williams said.

For more information from the Diagnostic Imaging archives:

CMS gets an earful on reimbursement for coronary CTA

CMS plans reimbursement cut, self-referral restrictions in 2008

Local variations in coronary CTA coverage spin heads