Medicare Compliance & Reimbursement - 2008 Issue 21
IMAGING: SPECT Coding Tops CMS' List of 'No Documentation' Errors--Now Medicare Is Watching
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Article Overview
This article covers CMS CERT findings related to SPECT myocardial perfusion imaging claims, with emphasis on why some claims were flagged for lacking supporting documentation and how that issue affects Medicare billing review. It also discusses coding-related topics involving CPT imaging services, including common reporting concerns and references to current CPT guidance and carrier policy language. The piece is aimed at coders, billing staff, and imaging practices that want to understand the scope of the Medicare attention and the general areas of compliance risk discussed in the article.
Why This Topic Matters
Medicare claim review can lead to payment denials, recoupments, or documentation requests when imaging services are not supported appropriately. Understanding the article’s scope helps practices recognize the coding and documentation issues being highlighted without exposing premium-only guidance.
Article Sections
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CMS CERT review and SPECT claim documentation
Discusses CMS review activity involving SPECT claims and the broader documentation concerns that led to scrutiny. The section frames the compliance context for Medicare payment review.
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Avoid billing 76376 with SPECT
Addresses a common coding pairing concern involving CPT imaging services and notes that the article references updated CPT guidance. It focuses on the topic of code relationship and reporting consistency.
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Report 1 code for resting/stress
Covers the reporting of multiple SPECT imaging studies performed in one encounter and the general issue of whether separate scans require separate reporting. It also notes that carrier policy language is referenced as part of the discussion.
What You Will Learn
- How CMS CERT review can draw attention to SPECT imaging claims
- Which documentation-related issues are discussed for Medicare claims review
- What general CPT imaging coding topics are addressed in relation to SPECT reporting
- How carrier policy language can relate to reporting of multiple imaging studies
Who Should Read This
- Medical coders
- Radiology billing staff
- Imaging practice managers
- Compliance staff
- Medicare billing specialists
Codes Discussed
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