A: No, telemedicine codes should not be used as stand-alone codes or in conjunction with radiology codes to report any teleradiology or tele-imaging service performed.
Formal complete imaging interpretation and reporting services are excluded from any telemedicine services. When formal imaging interpretation and reporting services are provided either on-site or remotely (the latter using established tele-imaging standards), such services are appropriately described by the existing radiology CPT® codes. For example, the formal interpretation of any chest x-ray is appropriately reported by one of the radiologic examination codes 71010, 71015, 71020, etc.
The Medicare Benefit Policy Manual, Chapter 15, Covered Medical and Other Health Services, Section 270.2 identifies telemedicine services as:
A: Pending creation of a new code, the ACR's position is that, unless a specific payer has advised otherwise (some private payers are requesting use of the temporary HCPCS code S8093), the new work of coronary CT angiography should be reported using the unlisted computed tomography procedure code (76497).
According to the CPT coding guidelines (p. xiii, CPT 2005 code book) you should "select the name of the procedure or service that accurately identifies the service performed. Do not select a CPT code that merely approximates the service provided. If no such service exists, then report the appropriate unlisted procedure/service code."
As noted in the Jan/Feb 2005 ACR Radiology Coding Source™, the typical acquisition and postprocessing protocols used for CTA of the chest are for pulmonary embolism or aortic dissection, which do not supply the information needed for exclusion of coronary artery occlusive disease. Acquisition and postprocessing algorithms dedicated to evaluation of coronary vessels are used instead of those employed for a conventional CTA of the chest examination. The CT techniques for high-quality coronary CTA are vastly different from the examinations described by 71275 with respect to field of view, slice thickness, gating requirements, reconstruction algorithms, and even scanner requirements. Therefore, since the coronary CTA is not accurately described by CTA of the chest, it would not be appropriate to report code 71275.
New Category III codes will take effect in January of 2006. Look for updates to the coding of coronary CTA in the July/August ACR Radiology Coding Source™.