June 7, 2008
The following information was provided by the American College of Radiology (ACR) to clarify any confusion about the appropriate coding for CAD for Breast MRI.
According to ACR, the appropriate code to use for the reporting of CAD associated with MRI of the Breast is CPT Catergory III code 0159T (implemented July 1, 2006). The ACR and American Medical Association have published a number of articles on the appropriate use of this code, and they are as follows:
- The Spring 2007 issue of Clinical Examples in Radiology, first question p. 8, clearly states that 0159T should be used to describe any type of CAD performed in conjunction with an MRI of the breast:
Q: The descriptor of 0159T specifices Computer-aided detection including computer algorithm analysis of MRI image data for lesion detection/characterization, pharmacokinetic analysis, with further physician review for interpretation, breast MRI. Is it appropriate to report computer-aided detection (CAD) when performed in conjunction with breast magnetic resonance imaging (MRI), but hwne pharmacokinetic analysis is not performed?
A: Yes, Catergory III code 0159T should be reported to describe CAD even though pharmacokinetic anaylsis was not performed. Code 0159T should be used to describe any type of CAD performed in conjunction with an MRI of the breast. The phrase "including computer algorithm analysis of MRI image data for lesion detection/characterization, pharmacokinetic analysis" in the descriptor clarifies that this code includes this type of anaylsis if performed, and it should not be coded separately. Code 0159T is an add-on code to a breast MRI procedure and, therefore, must be reported in addition to one of the breast MRI without and/or with contrast codes (77058 for unilateral and 77059 for bilateral). Because the CAD software automatically performs three-dimensional (3D) imaging, the CAD procedure code was valued to include 3D imaging. Multiplanr reformatting and subtraction should not be coded in addition to the CAD code. As noted in the Winter 2007 issue of Clinical Examples of Radiology, an order is not required for the performance of CAD becasue this is covered under the Ordering of Diagnostic Tests design exemption.
- The June 2008 AMA CPT Assisstant is scheduled to publish clarification on the use of this code as well.
- The ACR Radiology Coding Source Q&A section published the following with regard to the reporting of 0159T:
July/Aug 2007
Q: How should the use of computer-aided detection software be reported for breast sonography services?
A: Computer-aided detection (CAD) performed in conjunction with breast sonography is reported with Current Procedural Terminology (CPT) code 76999 (unlisted ultrasound procedure (e.g., diagnostic, interventional)) to describe the CAD analysis and CPT code 76645 (ultrasound, breast(s) (unilateral or bilateral), real time with image documentation) to describe the breast ultrasound study. Although CAD codes have been established to be used in conjunction with diagnostic and screening mammography (77051, 77052) and breast magnetic resonance imaging (MRI) (0159T), no code is available to be used in conjunction with breast ultrasound; therefore, the unlisted procedure code should be used to report this service.
Jan/Feb 2006
Q. How do I code for the use of computer-aided detection (CAD) performed in conjunction with an MRI of the breast?
A: At this time, the unlisted procedure code 76498 should be used to describe CAD when performed in conjunction with an MRI of the breast. The MRI of the breast is reported separately using code 76093 (unilateral) or 76094 (bilateral).
Note that 3-dimensional reconstructions, subtraction and angiodynamic assessment performed in conjunction with CAD are included in the CAD procedure base code and are not coded separately. The 3-D imaging is an inherent and intrinsic part of the CAD software and is thus included in the unlisted procedure code 76498. In this setting, 3D imaging should not be separately reported by CPT® codes 76376 (3-D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; not requiring image postprocessing on an independent workstation) or 76377 (3-D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; requiring image postprocessing on an independent workstation).
A category III add-on code (+0159T) was recently approved by the CPT Editorial Panel to describe the use of CAD for MRI of the breast which will become effective for use July 1, 2006. This new code will similarly include all inherent 3-D imaging (which should not be reported separately with 76376 or 76377). Until July 1, however, the unlisted CPT code should be assigned to describe this additional work.
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