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How to bill a CT scan covering several segments?
Understand how percentages are applied to imaging tests covering multiple areas of the spine under the CBHPM, with a focus on the rules for operating costs and the valuation of radiological film to ensure accurate billing of complex cases
- By
- Rivio, Editorial team
- Published
- Reading time
- 2 minutes
How do you bill a Computed Tomography scan with more than 3 segments?
Rivio answers
To illustrate how the calculation for billing the additional segments should be done, we will use a fictitious clinical case in which the patient underwent a spine CT scan with 15 segments.
We will use the information from the Brazilian Hierarchical Classification of Medical Procedures (CBHPM) of October 2016, for teaching purposes only.
| Code | Value (R$) | Code | Value (R$) | Code | Value (R$) |
|---|---|---|---|---|---|
| 1A | 17.38 | 5C | 394.11 | 10B | 1,306.09 |
| 1B | 34.75 | 6A | 429.25 | 10C | 1,449.67 |
| 1C | 52.14 | 6B | 472.04 | 11A | 1,533.70 |
| 2A | 69.53 | 6C | 516.33 | 11B | 1,681.88 |
| 2B | 91.65 | 7A | 557.58 | 11C | 1,845.34 |
| 2C | 108.46 | 7B | 617.15 | 12A | 1,912.54 |
| 3A | 148.20 | 7C | 730.18 | 12B | 2,056.14 |
| 3B | 189.37 | 8A | 788.24 | 12C | 2,518.99 |
| 3C | 216.92 | 8B | 826.43 | 13A | 2,772.57 |
| 4A | 258.16 | 8C | 876.83 | 13B | 3,041.43 |
| 4B | 282.61 | 9A | 931.84 | 13C | 3,363.75 |
| 4C | 319.27 | 9B | 1,018.91 | 14A | 3,748.70 |
| 5A | 343.70 | 9C | 1,122.76 | 14B | 4,078.67 |
| 5B | 371.21 | 10A | 1,205.27 | 14C | 4,498.75 |
UCO = R$ 19.36
The only piece of information used in the calculation that is not provided by the CBHPM table is the price per m² of radiological film. The CBHPM table gives us the amount of film used, but the price per m² of radiological film must be set out in the contract with the payer.
The radiological film calculation is done as follows:
Amount of film used according to the CBHPM x Price per m² agreed with the payer.
In this case, as an example, we will use a price of R$ 27.00 per m².
The spine CT scan performed covers 3 segments, so we will have to calculate the value of the 12 additional segments (15-3=12). To do this, we will follow the notes to Chapter 4 of the CBHPM, in this specific case item 4 of the notes.
Item 4 states that we must charge 100% of the main procedure or the one with the highest tier, and 70% of the cost value of each of the other tests performed.
Knowing that the tier value of the CT scan is higher than the value of the additional segment, we must apply a 30% discount to the operating cost of the additional segments.
Total for the CT scan with 15 segments: R$ 527.55 (CT scan and 3 segments) + R$ 1,483.68 (12 additional segments) = R$ 2,011.23
