+ What does the CAD analysis look like?

      PlusCAD provides a paper printout of the CAD analysis which includes digitized mammography images with markings detected by the computer.

 

 

 

 

 

 

 

 

 

+ How much does it cost to contract with PlusCAD?

      There is no cost to the facility or radiologist to contract with PlusCAD. The facility bills third party payors for CAD analysis as an add-on procedure code to the mammogram. PlusCAD will bill the facility on a fee-per-study basis for each analysis performed.  PlusCAD’s fees are established below Medicare’s reimbursement rate for AMA-CPT codes #77051 and 77052 for diagnostic and screening mammography CAD analysis. This enables the facility and interpreting radiologist the opportunity to generate additional revenue.

 

+ Do all payors reimburse for CAD analysis?

The Benefits Improvement and Protection Act (BIPA) 2000, established coverage and payment of computer-aided detection (CAD) in conjunction with the performance of a mammogram. Medicare and the majority of third-party payors provides additional reimbursement for mammography CAD. Aetna “considers computer-aided detection (CAD) a medically necessary adjunct to mammography.”  Blue Cross Blue Shield Technology Assessment concluded “...the available evidence suggests that the use of CAD after initial radiographic interpretation as a quality adjunct to single-reader mammography in patients having film-screen mammography improves net health outcomes compared with single-reader radiologist interpretation by increasing true-positive rate without a disproportionate increase in the false-positive rate.”   

 

+ What CPT codes are used to bill for CAD analysis?

77051: Computer aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation, with or without digitization of film radiographic images, diagnostic mammography (list separately in addition to code for primary procedure).

77052: Computer aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation, with or without digitization of film radiographic images, screening mammography (list separately in addition to code for primary procedure).

 

+ When should we bill for CAD analysis?

      CAD analysis CPT codes are established as add-on codes to the primary mammography procedure, therefore, the CAD CPT codes must be billed with the primary mammogram code. 

 

+ How much does CMS (Medicare) reimburse for mammography CAD?

       To determine the CMS reimbursement allowance for your locality, visit the physician fee schedule lookup page on CMS’s web site:  http://www.cms.hhs.gov/apps/ama/license.asp?file=/pfslookup/02_PFSsearch.asp

 

+ How is the radiologist compensated for CAD interpretation? 

PlusCAD’s contractual relationship is with the certified mammography facility. The facility will maintain their current relationship with their professional radiology group for interpretation of radiologic procedures including mammography CAD analysis that is reimbursed by the majority of third-party payors.

 

+ How much additional time does it take to interpret the CAD analysis?

The CAD analysis printout is viewed at the time the mammogram is interpreted, therefore, additional time required is minimal. A study was conducted to determine the impact of CAD on radiologist’s workflow. On average, the use of CAD technology required an additional 17 seconds of radiologist’s time.

  

+ Is a referral from a physician for CAD required?

The Centers for Medicare & Medicaid Services informed the ACR that interpretation of the Ordering of Diagnostic Tests Rule (42 CFR 410.32) allows for performance of computer-aided detection (CAD) in conjunction with mammography without a written order from the referring (treating) physician.

  Since there is no medical necessity prerequisite for the use of computer-aided detection with mammography procedures, and if all aspects of CAD are performed in conjunction with mammography, the radiologist may determine whether or not CAD should be performed. The use of CAD in conjunction with mammography is covered under the "Radiologist Exception" as noted in the CMS clarification in the Medicare Carriers Manual Transmittal #1725:  15021 (E)(1) Test Design - Unless specified in the order, the radiologist may determine, without notifying the treating physician/practitioner, the parameters of the diagnostic test (e.g., number of radiographic views obtained, thickness of tomographic sections acquired, use of non-use of contrast media).

 

+ Does PlusCAD provide CAD services for both screening and diagnostic mammograms?

PlusCAD offers CAD analysis services for either screening or diagnostic mammography based on the mammography provider’s preference and impact on clinical operations. Most facilities elect to utilize PlusCAD services for their screening mammography population to ensure continued prompt results reporting for diagnostic patients. Some clients separate their diagnostic population into symptomatic and asymptomatic and perform CAD analysis on mammograms rendered to asymptomatic patients for which there is minimal impact associated with a slight delay in results reporting.   

 

+ What impact will PlusCAD have on workflow?

Once it is determined what type of mammograms that will be sent for CAD analysis, you should identify employees that can easily segregate the cases. Most likely, this will be the technologist’s role. PlusCAD will provide a film container to hold the films until the scheduled pickup time. We recommend that you maintain the container in the location where CAD studies are identified (i.e., technologist work area). Simply have the technologist insert the films in folders and place them in the container after they perform the examination. It is advisable to designate an area to hold master jackets of patient studies that have been sent to PlusCAD for processing. This will simply the process of matching returned films/CAD studies with the patient’s prior films to prepare for interpretation. 

 

+ Are there special requirements to process the films?

The facility must supply the original mammogram films acquired utilizing a film-screen mammography system. The films must be  labeled with radiopaque film markers to  indicate laterality and mammographic view in accordance with requirement of the Mammography Quality Standards Act. The films must be free of tape, stickers, or artifacts.

  If the facility routinely performs additional mammography views (i.e. magnification or spot views) the facility should provide PlusCAD the standard 4-views separated from the special views.

 

+ How are the films transported? 

PlusCAD’s utilizes courier services and FedEx® Express for film delivery services based on location. FedEx® was selected due to their standard of excellence in customer service and rapid, reliable, time-definite delivery of documents and packages nationwide. FedEx® is the world's largest  express transportation company with a state-of-the-art information technology network that  offers web based real-time tracking information on the status of  shipments.

 

+ What if the mammograms are lost during shipment?

PlusCAD acknowledges the remote possibility that a package may be delayed or lost. In this event it is necessary to repeat mammograms, PlusCAD will reimburse the facility for each procedure at the current CMS screening mammography reimbursement rate and perform the CAD analysis at no charge. We realize that this happening presents a tremendous inconvenience, however, the improbability of this occurrence should provide some reassurance to mammography providers and the women they serve. 

 

+ What is the frequency of film pickup and delivery? How does the mammography facility prepare the package for shipment?  

PlusCAD will establish a pickup and delivery schedule based on volumes and client preference and provide shipping supplies and pre-paid labels. All the facility is required to do is insert the films in the shipping box and affix the mailing label. PlusCAD will handle the transportation logistics and monitor the shipment.

 

+ How long does it take for PlusCAD to return the films? Will the process delay results reporting?

The mammogram films and CAD printout are typically returned to the facility in less than 48 hours. Although this may delay results reporting, women are generally receptive to a minimal  delay for computer analysis. MQSA requires facilities to communicate mammography results within 30 days of the examination, therefore, utilizing PlusCAD’s services will not impact on the facility’s ability to comply with federal regulations.

 

+ Why should I consider PlusCAD? 

The founder and President of PlusCAD is a Registered Technologist with extensive experience in breast  imaging and clinical operations. Since our inception in 2002, more than 235,000 CAD procedures have been performed without a significant service failure. Customers reluctant to transport films are assured by our 100% film return rate — a film has never been lost!  PlusCAD’s staff possesses the  essential knowledge and experience in mammography and CAD applications required to deliver the highest quality service to our customers. Our expertise is mammography CAD—our business is service!    

 

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To contact us:

PlusCAD, Inc.

930 William Pitt Way

U-PARC, Building A4, Suite #118

Pittsburgh, PA 15238

 

Phone: 1-888-665-8580

Fax: 412-826-3005

E-mail: info@pluscad.net   

Website:  www.pluscad.com