Hello, colleagues, I'm here today to talk to you about CPT code reporting for non-invasive imaging, and I do serve on the Caliber ID Board of Directors. RCM, long form is reflectance confocal microscopy, has CPT codes that are the special dermatologic procedure section of CPT, the same place as you find the laser codes, visceriasis, and a bunch of other dermatology codes that didn't fit elsewhere. These have been real codes since 2016, and they've been valued by CMS since 2017. To use these codes, you have to have a Bibiscope 1500, and this can be in your clinic, your NP or PA satellite, or your local primary care group that sends patients to you. The Viviscope 1500 gets both stacks and mosaics when it captures images. Stacks are where you can look at different levels of the skin going down deeper from the surface, and mosaics are where multiple small pieces are stitched together, and this is a necessity for using these codes. And who will use these codes? CMS, hopefully, as dermatologists, but it could be pathologists, it could be radiologists as they like to do imaging, and this is basically a form of imaging. I hope we can hold on to this. Now all of the codes, there are six of them, have an introductory language that describes the acquisition and or diagnostic interpretation of the device, generated stitched images and mosaics related to a single lesion, and you don't report these for any examination that does not produce mosaic images. And for surfaces rendered using reflectance confocal microscopy not generating mosaic images, use 96999, the miscellaneous code. RCM, for cellular and subcellular imaging of skin, image acquisition interpretation and report first lesion. This is like a global code in pathology or radiology. If you're only capturing but someone else is doing it, use 96932, and if you're only the reader, use 96933. Again, we have three codes for the initial, and we have another three codes for the add-on lesion, 96934 is where you both capture and read, 96935 is where you capture but don't read it, and 96936 is where you read but don't capture. Why do we have this? Instead of the technical and professional component split of 88305 in pathology and all of the other path and radiology codes, the answer is simply that we're in a section of CPT book that doesn't allow this, and we took what we could get. Now that first lesion, again, just to emphasize that, the global is the 96931 where you both capture and read, the 96932 is acquisition only for the first lesion, 96933 is interpretation report only. The add-on codes are very similar with the same sort of split. So if 96931 and 96934, your staff capture the image and you read it, for 96932 and 96935, your staff capture the image and someone else reads it, and for 96933 and 96936, someone else captures it and you read it. I know we're repeating this a lot, but I've been amazed at how long it takes some people to get this down. Now just some global period trivia here, the 96931, 2 and 3 are base codes. Any of these three stands alone, and on any given day, only one of these will be used one time per patient, similar to the first biopsy, only one per patient per day. 9693456, or add-on codes, can be used if reporting one of the base codes, and that's like 11103, an add-on biopsy, or 17003, an add-on to premalignant destruction. The viviscope 1500 is the only system that can be reimbursed under the CPT codes we are reviewing. While the viviscope 3000, also known as the handhold, is a wonderful device, it is not covered under these codes. Now in the present, we do have values, and this is a chart of the 2023 national average confocal microscopy payments on here. You can see the global pays 17384, the technical component is 12979, and the reading is 4405, and each additional reading, each additional lesion, is 12064 for the global, 7896 for the technical, or 4186, 4168 for the professional component. Now there are some payment heroes that we do need to recognize. When this went through both the CPT process, where the codes are defined, and the RUC where they are valued, Dr. Jane Grant Kales and Harold Rabinovitz were all-stars, and the all-stars also included those who filled out the RUC surveys, never a fun task. Now for payments, you simply report the code to an insurer, as you do now, and put in your charges as you would for any other code. Link with a D48.5 neoplasm of certain behavior of skin diagnosis, you should be fine if you are capturing only, and readers should use the proper ICD-10 codes for the diagnosis. And of course, you just do what you document, document that which you did that is medically necessary, and you should never get yourself in trouble, and that's paraphrasing David McCaffrey, the first AAD RUC member. If you're capturing only, document that the image was captured with a Vivascope 1500 and sent to a reader. If reading, document as you would a PATH report for an 88305, keep your images just as you would your gas slides, and be prepared to make a call of three if the claim is rejected, and do good for your patients. For private insurers, many will follow Medicare RVU guidance, some may not. Be thoughtful and charge fairly. My personal opinion is to ask on the high side, why charge low when payers will likely discount what you are doing, but remember pigs and hogs. Pigs get fat, hogs get slaughtered. Now what if my Medicare intermediary says no to paying for the service? You might remind them that there is now a genuine Category 1 CPT code set for the procedure, that is status A, not experimental, and an accepted code for an accepted procedure. What does this mean? The system has received FDA clearance, the procedure or service is consistent with current medical practice, and the clinical efficacy of the procedure or service is documented in literature that meets the requirements set forth in the CPT code change application. Now a critical reminder is only the Caliber ID, Vivascope 1500, the handheld is not cleared for this purpose and should not be used when reporting this code. You would use the 96999 if you report the handheld. Now some facts. What should you be reimbursed? Simply visit the CMS website, fee schedule lookup, and you can simply go to this by clicking on the begin search button, and voila, you're in a search. You pick the year, you pick the type of info you want, and you just keep trucking your way through here. You pick the range of codes, we've picked the full range. You can take all modifiers, easiest thing to select on here. And then you decide where you want to look for. You can look at all MACs. And then when you're done with doing this, you can simply download these and open it up in your favorite spreadsheet folder. You can pick your MAC locality. Here we've just picked rest of Florida since that's where Dr. Rabinovitz and Grant Kelzer are these days. And voila, you have the values and the RVs and everything else you need. So summary, we have six codes for reporting RCM when performed on the Vivascope 1500. When you image a lesion, report it with a fee you choose and help your patients. I do want to also mention Optical Coherence Tomography, OCT, which is another evolving technology. The literature to get a Category 1 regular CPT code was not available. The company obtained Category 3 codes, which are tracking codes, which have a limited lifespan. And these were sunset on January 1st of 2023. If you want to read more and learn more about this technology, the AAD has some great resources and they are shown here. And there's also a PDF of the Academy position paper on reflectance confocal microscopy that you can get. And I do thank you for listening today and hope you have enjoyed the presentation.

CPT code reporting

reflectance confocal microscopy

Caliber ID Vivascope 1500

dermatologic procedure

Optical Coherence Tomography