MPM Publications
In the October 2004 issue of Radiology Coding Alert, there was an important article regarding the billing of 3-D Reconstruction views. There was an investigation by the OIG (Office of Inspector General) and a pending lawsuit against a Florida Radiology group for inappropriate billing and one of the major issues mentioned by the OIG was billing for 3-D reconstruction views because the group could not produce a written order to prove medical necessity for this procedure.
Although the ACR holds the position that it is not necessary to have a separate order for this procedure, we must follow the guidelines of CMS (Centers for Medicare and Medicaid) as authoritative. However, due to this recent investigation and the accusations made by the OIG, CMS and the ACR are working together to decide if this procedure should be exempt from the test ordering rules. We expect to hear a decision and guidelines issued from CMS by the beginning of 2005.
At this time it is advisable to no longer bill for the CPT code for Reconstructive views unless there is a written order or there is an absolute medical necessity. If either of these is the case, please provide your billing staff with the necessary documentation. Until the final ruling comes down from CMS, we advise all Physicians to take a more conservative route.
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