COMPUTED TOMOGRAPHY Chest/Cardiac Assignable revenue codes: 0350 CT Scan General Classification 0351 CT Scan Head Scan 0352 CT Scan Body Scan 0359 CT Scan Other CT Scans Explanation of services: Known as either chest CT, CT of the chest, or CT of thorax, all are defined by codes 71250 71275. This study is normally done in a single transverse plane. Referred to as cardiac scoring, calcium scoring, CCT, or CCTA, these procedures are defined by CPT codes 75571 75574. CPT also provides a separate charging option for performing CTA as well as conventional CT imaging. Medicare Physician Fee Schedule RVUs and Hospital OPPS Rates Under APCs CPT/HCPCS Code Modifier MPFS RVUs Hospital OPPS Global Status Nonfacility Facility SI APC Payment Rate 71250 26 XXX A 1.46 1.46 Q3 5522 $112.69 71260 26 XXX A 1.78 1.78 Q3 5571 $264.90 71270 26 XXX A 1.97 1.97 Q3 5571 $264.90 71275 26 XXX A 2.60 2.60 Q3 5571 $264.90 75571 26 XXX A 0.82 0.82 Q1 5521 $59.84 75572 26 XXX A 2.47 2.47 S 5571 $264.90 75573 26 XXX A 3.60 3.60 S 5571 $264.90 75574 26 XXX A 3.38 3.38 S 5571 $264.90 G0296* Global XXX A 0.80 0.75 S 5822 $70.23 G0297* Global XXX A 7.14 S 5521 $59.84 Codes 71250 71270 71250 CT, thorax; without contrast material 71260 CT, thorax; with contrast material(s) 71270 CT, thorax; without contrast material, followed by contrast material(s) and further sections These scans may be ordered to evaluate abnormal or suspected abnormal areas of the lungs, pleura, chest wall, mediastinum, and recently the heart. Another 51
is chest CT to detect pulmonary embolism (PE). Dynamic studies are not charged any differently than typical procedures. Code 71275 71275 Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing CTA is a method of imaging vascular anatomy in a minimally invasive way. Usually, but not always, a CT imaging sequence without contrast is performed for localization of the site to be studied during the enhanced scan (with contrast). To reflect that not all CTA studies include these non-contrast images, each CTA code descriptor states with contrast material(s), including noncontrast images, if performed. Although separate reimbursement may be allowed when contrast material is administered via an intravenous (IV) method for this study (verify local payer requirements and rules), do not charge separately for the surgical code for the venous injection of this material. CCI narrative instructions state the following (Chapter 9, subsection D, #1): If a radiologic procedure requires that contrast be administered orally (e.g., upper GI series) or rectally (e.g., barium enema), the administration is integral to the radiologic procedure, and the administration service is not separately reportable. If a radiologic procedure requires that contrast material be administered parenterally (e.g., IVP, CT, MRI), the vascular access (e.g., CPT codes 36000, 36406, 36410) and contrast administration (e.g., CPT codes 96360 96376) are integral to the procedure and are not separately reportable. While other methods may be used to study arteries and veins (contrast arteriograms and/or venograms), CTA studies are performed by rapid injections of contrast material to allow computer processing of the acquired data into threedimensional images. The resultant images can then be further manipulated and/or adjusted for precise analysis and viewing of any atypical venous or arterial anatomy. 3-D post-processing must be performed to assign a CTA code. It is inappropriate to also use codes 76376 or 76377 for that portion of study, as the definition of all CTA codes explicitly includes image post processing. NCCI, Chapter 9, subsection D, #9 states: Computed tomography (CT) and computed tomographic angiography (CTA) procedures for the same anatomic location may be reported together in limited circumstances. If a single technical study is performed which is utilized to generate images for separate CT and CTA reports, only one procedure, either 52
the CT or CTA, for the anatomic region may be reported. Both a CT and CTA may be reported for the same anatomic region if they are performed at separate patient encounters or if two separate and distinct technical studies, one for the CT and one for the CTA, are performed at the same patient encounter. The medical necessity for the latter situation is uncommon. CT CHEST W/ CONTRAST Clinical Indication: Abnormal pulmonary scan. Technique: Volumetric low dose helical CT imaging of the chest was performed on the GE 64 slice VCT with ASIR dose reduction. 50 cc of Isovue 370 non-ionic contrast was injected without adverse reaction. FINDINGS: Lungs and Pleura: There is a moderate centrilobular and paraseptal emphysema. There is biapical scarring. Brochiectasis with areas of mucoid impaction is similar to the prior. There are nodule opacities scattered throughout both lungs, many of which are stable and probably reflect areas of mucoid impaction. A few opacities appear increased bilaterally. There is no pleural effusion or pneumothorax. Mediastinum: Overall heart size is within normal limits though the right atrium and right ventricle are mildly prominent. There is moderate atherosclerosis of the thoracic aorta. Central pulmonary arteries are mildly prominent, with the left pulmonary artery measuring the same caliber as the descending aorta suggesting pulmonary hypertension. There is no suspicious adenopathy in the chest. Bone and Soft Tissues: No acute bony abnormality. Mild degenerative disc disease in the thoracic spine. Impression: Emphysema with bronchiectasis and mucoid impact. Bilateral pulmonary nodules, a few of which appear increased. No dominant lesion is seen, and continued follow up is recommended. CPT Code: 71260 53
CT ANGIOGRAM CHEST (PE) W/ CONTRAST Clinical Indication: Dyspnea on exertion, heart palpitations, SOB Technique: Volumetric low dose 0.625 mm helical CT pulmonary angiography was performed utilizing the GE 64 slice VCT with ASIR dose reduction. 80 cc of Isovue 370 non-ionic contrast injected without adverse reaction. 3D imaging including maximum intensity projection (MIP) images was generated from the source data. FINDINGS: Mediastinum: Pulmonary arteries are well-opacified. There is no suspicious filling defect to suggest pulmonary embolism. There is minimal atherosclerotic calcification of the thoracic aorta, which is otherwise unremarkable. The heart size is normal. There is no evidence of right heart strain. No suspicious adenopathy in the chest. Lungs and Pleura: There is no consolidation or suspicious pulmonary nodule. Mild bronchiectasis is noted. No pleural effusion or pneumothorax. Bones and Soft Tissue: There is mild rightward thoracic curvature and mild multilevel degenerative disc disease. Bilateral breast augmentation is noted. Impression: No evidence of acute pulmonary embolism. Mild bronchiectasis. CPT Code: 71275 Note: The above two reports appear to be very similar in regard to the findings noted. One of a Chest CT and the other is a Chest CTA. Documentation of 3D imaging including maximum intensity projection (MIP) images (or other similar language) differentiates a CTA from a CT. Codes 75571 75574 75571 Computed tomography, heart, without contrast material, with quantitative evaluation of coronary calcium 75572 Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology (including 3D image postprocessing, assessment of cardiac function, and evaluation of venous structures, if performed) 75573 Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology in the setting of congenital heart disease (including 3D image postprocessing, assessment of LV cardiac function, RV structure and function and evaluation of venous structures, if performed) 54
75574 Computed tomographic angiography, heart, coronary arteries and bypass grafts (when present), with contrast material, including 3D image postprocessing (including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluation of venous structures, if performed) According to the AMA, the codes include the precontrast axial source images, both arterial and venous phase sequences (if performed), as well as 2-D and 3-D reformatted images. There is no longer a separate add-on code for a function study as that is now included in the base codes. Tips Only one CT code defining the heart is reported per patient encounter (July 2010 AMA CPT Assistant). CT of the heart (CPT codes 75571 75573) and CTA of the heart (CPT code 75574) include electrocardiographic monitoring if performed. CPT codes 93000 93010 (electrocardiogram [ECG]) and 93040 93042 (rhythm ECG) should not be reported separately with CPT codes 75571 75574 for the ECG monitoring integral to these procedures. NCCI, Chapter 9, subsection D, #9 states: Computed tomography (CT) and computed tomographic angiography (CTA) procedures for the same anatomic location may be reported together in limited circumstances. If a single technical study is performed which is utilized to generate images for separate CT and CTA reports, only one procedure, either the CT or CTA, for the anatomic region may be reported. Both a CT and CTA may be reported for the same anatomic region if they are performed at separate patient encounters or if two separate and distinct technical studies, one for the CT and one for the CTA, are performed at the same patient encounter. The medical necessity for the latter situation is uncommon. Do not use codes 76376 or 76377 for routine 2-D reconstruction (i.e., sagittal and/or coronal images). 2-D reconstruction is considered a base component of CT imaging and is not separately reportable. The 3-D codes require concurrent supervision, which means that the radiologist must actively participate in the reconstruction process. He or she either must do the reconstructions or direct the technologist to the area to be reconstructed, decide on the structures to be displayed, and otherwise monitor the process. Relative to CT or MR studies, codes 76376 or 76377 are only potentially reportable with CT or MRI, not CTA or MRA. Bundled codes like 55