CMR Codes

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Coding Updates

New CPT Codes form Quantitative Myocardial Blood Flow – 2024.01.25

The Society for Cardiovascular Magnetic Resonance (SCMR) is pleased to share some exciting news. Our continuous efforts to develop a coding strategy to enhance and modernize our medical coding practices has led to the introduction of two new Current Procedural Terminology (CPT) Category III codes effective July 1, 2024, for reporting Absolute Quantitation for Myocardial Blood Flow for Cardiac MRI services. These new CPT codes were announced by the AMA on January 1, 2024.

Source: https://www.ama-assn.org/practice-management/cpt/category-iii-codes

These codes were developed to facilitate appropriate coding for Stress cardiac magnetic resonance (CMR) services in patients with obstructive CAD who have stable chest pain symptoms undergoing either stress PET MPI or stress CMR, as the addition of myocardial blood flow reserve (MBFR) is useful to improve diagnosis accuracy and enhance risk stratification. This is widely accepted as an option for the evaluation of chest pain, as recognized by the most recently published, multi-societal 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.

These new codes are the result of work by SCMR’s U.S. advocacy team, in collaboration with both the American College of Cardiology and the American College of Radiology, reflecting our commitment to updating the coding strategy for CMR services.

The new codes will be published in the 2025 edition of the AMA CPT Code Book.

SCMR is planning a series of webinar to explain in more details to members the accomplishment, how to submit this new code and potential implications for reimbursement.

Stay tuned!

Important Medicare Billing Announcement – 2023-10-06 (information also posted under Coding Updates above)

We know that some of the most complex patients are our ones with congenital heart disease, and they are most vulnerable.  And that the time it takes to evaluate them is extraordinary and a labor of love.

SCMR teamed up with the American College of Radiology, the Radiological Society of North America, the American Roentgen Ray Society, and the American Association of University Radiologists, and we wrote letters to the Centers for Medicare & Medicaid Services (CMS) requesting permission to bill the flow mapping billing code (CPT 75565) multiple times if medically necessary for certain patients (e.g. CHD patients), as usually many flow measurements are necessary.  After subsequent appeals and multiple phone calls, the result was extraordinary!

Starting October 1^st, 2023, if medically necessary, you may now bill the velocity flow mapping CPT code 75565 up to four times per patient per day.  Note that CPT 75565 is an add-on code and should be reported in conjunction with the cardiac magnetic resonance imaging for morphology and function codes 75557, 75559, 75561, and 75563.

It is important to document what valves/vessels/shunts/baffles you obtained flows on in the report, and state the numbers clearly.  An example is:

Technique:  xxx Flow quantification was performed 4 times during this examination with flow quantification performed at the levels of the ascending aorta above the valve, pulmonary artery above the valve, and at the right and left pulmonary arteries.

NOTE:  This is only an example, and you must provide documentation according to your specific case.

— Work with your billers and coders at your institution —

• Some institutions will bill directly off the report.
•   Some order sets have a separate accession number for each billable CPT code.  This may be ordered at the time by the physician and/or registered by the tech (so called “orderable, performable” in some EHRs).
• Please touch base with your administrator regarding your local MUE edits.  For example, if you have an EHR like EPIC, it may be built in that you can only charge 75565 once, and will need to change the MUE from 1 to 4
• This is a perfect time to work with your administrators to improve recognition of your time and effort that has benefits for your patients and your health system!

CMS posted this revision in the National Correct Coding Initiative (NCCI) Medically Unlikely Edits (MUE) update in September 2023, effective October 1, 2023.  https://www.cms.gov/files/zip/medicare-ncci-practitioner-services-mue-table-effective-10012023.zip

For questions, it is best to contact your Medicare Administrative Contractor (MAC) for jurisdiction – specific guidance and direction on claims submission. Make sure to also consult your Medicare Advantage Plan if you are an enrolled provider.  Always note the date, time, name of the representative, and a call identifier or case number for future reference.

Background

In brief, regarding the National Correct Coding Initiative (NCCI) and Medically Unlikely Edits (MUEs), the Centers for Medicare and Medicaid Services put in place NCCI edits to promote national correct coding methodologies and reduce improper coding, with the overall goal of reducing improper payment of Medicare Part B and Medicaid claims.  Part of this work is done is through NCCI Procedure to Procedure (PTP) edits.  This is a list of codes that cannot be billed together .  Another part of NCCI is the Medically Unlikely Edits (MUE) program to prevent improper payments when services are reported with incorrect units of service.  For example, CPT 75565 has been limited to 1 unit of service per patient per day. The CMS Medicare Administrative Contractors are private insurers that have been awarded a contract by CMS to administer the Medicare program regionally.  There are currently 12 MACs.   MACs implement NCCI edits through their claims processing systems.