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Radiology Coding Alert

News Brief:
Medicare Allows PET Scan, MRA for New Diagnoses

Medicare offered radiologists a double-dose of good news in April with two new decisions outlining expanded magnetic resonance angiography (MRA) and positron emission tomography (PET) coverage. MRA Coverage Applauded On April 15, CMS released decision CAG-00142N, which expands MRA coverage to include the following services:

MRA to evaluate renal arteries in patients in the absence of aortic aneurysm or dissection

MRA to evaluate pelvic arteries in patients in the absence of aortic aneurysm or dissection

Catheter angiography in addition to MRA when clinically warranted (although the exact indications are at the individual carrier's discretion). "In the past, pelvic MRAs (72198, Magnetic resonance angiography, pelvis, with or without contrast material[s]) were noncovered by CMS," says Jeff Stanco, business office manager at Jacksonville Medical Imaging in Florida. In addition, before CMS issued this decision, "Medicare only covered abdominal MRAs (74185, Magnetic resonance angiography, abdomen, with or without contrast material[s]) for very specific diagnoses, all of which pertained to aortic or abdominal aortic aneurysm or dissection."

Stanco reminds radiologists that this coverage is effective as of July 1, 2003, and the exact ICD-9 listing has not yet been published. In addition, the use of contrast angiography after MRA, while covered if clinically warranted, is at the local carriers'discretion. PET Scan Decision a Welcome Change CMS released decision CAG-00165N on April 16, expanding PET coverage to allow "the use of N-13 ammonia PET for the evaluation of myocardial perfusion (78491-78492) for the diagnosis or treatment of the illness or injury or to improve the functioning of a malformed body member in the population specified."

On the same date, CMS released decision CAG-00095N, which announced that Medicare will cover PET scans for thyroid cancer patients (78810, Tumor imaging, positron emission tomography [PET], metabolic evaluation). Strict coverage guidelines, however, may limit the decision's benefits. As the announcement now reads, the upcoming National Coverage Determination only supports imaging for the staging of thyroid cancer of follicular origins in patients who meet the following criteria: previously had a thyroidectomy and radiation ablation; possesses an elevated or rising serum Tg lab test of greater than 10 ng/ml; and previously had a negative I-131 whole body scan.

"Coders, billers, schedulers and compliance personnel will have to pay close attention to the process that verifies whether patients have met all of the requirements for this particular exam," says Mark McLeroy, BSRT, administrative specialist for radiology at University Hospital in Augusta, Ga.

National Coverage Decisions are available on the CMS Web site at www.cms.gov/ncdr/ncdr_index.asp.  


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