ACR Radiology Coding Source™ July-August 2003 Q and A

Q: What is the appropriate way to code a MR without contrast for bilateral knees? Because it is only one scan, we are debating the appropriateness of billing 73721 twice with the RT and LT modifiers.

A: If an MRI of the right and left knees was performed it would be appropriate to code 73721 (MRI, any joint of lower extremity; without contrast) twice along with the appropriate modifier (e.g., RT/LT) to designate that a bilateral procedure was performed. The CPT code descriptor specifies "extremity" in the descriptor, which indicates that this is a unilateral procedure.

Q: When placing a Tesio catheter (tunneled), is it appropriate to code twice if two ports are placed?

A: When placing a Tesio catheter (tunneled) or any type of implanted central venous access device, it is appropriate to code 36533 (Insertion of implantable venous access device, with or without subcutaneous reservoir) once, unless advised otherwise by the Medicare carrier. The physician decides whether to place a single or double tunnel device; however, the placement of either is typically reflected in the work of 36533.

Be sure to check the coding updates in the CPT 2004 manual, as revisions will be made to the central venous access codes, and the above coding recommendation will change.

Q: How do you code for a gastrostomy tube patency check for a previously placed tube?

A: When coding a gastrostomy tube patency check for a previously placed tube, it is appropriate to report 49424 (Contrast injection for assessment of abscess or cyst via previously placed drainage catheter or tube (separate procedure)) and 76080 (Radiologic examination, abscess, fistula or sinus tract study, radiological supervision and interpretation) if the radiologist injects the tube and monitors the exam with fluoroscopy. If only films are submitted for interpretation from a tube injection, code 76080 only would be appropriate.

Q: A MRI is performed on the spine covering the cervical region through T8. The patient is then repositioned, and a MRI is performed from T8 through the lumbar spine. One report is written describing the two studies and the findings. There are separate MRI codes (72141-72158) for each region of the spine. Since each of the MRIs performed crosses two spinal regions, is it appropriate to code each region?

A: It is appropriate to code for all three regions (cervical, thoracic, lumbar) of the spine since, as you describe it, a MRI of all three regions of the spine was performed and interpreted. Note that the number of surface coil positions does not determine the appropriate CPT code to use. It is recommended that three separate reports be dictated for the three separate regions studied.

Q: When the orthopedist uses the C-arm in the operating room during a reduction of ankle fracture, the hospital is coding 76000 for the use of the C-arm. Is it appropriate for the radiologist to code for a two-view ankle (post-reduction) if only a "soft" copy image (similar to an ultrasound thermal print) is provided for interpretation?

A: If the radiologist is not present in the O.R. during a reduction of an ankle, and the radiologist is asked to interpret a two-view study of the ankle from a soft copy image, and he/she renders a report, it would be appropriate for the radiologist to code for a two-view ankle study (73600).

If the radiologist is not present in the O.R., he/she should not submit a code for fluoroscopic guidance. However, if either the radiologist's contract with the hospital requires that a radiologist issue a formal interpretation, or if the physician performing the study requests that a radiologist produce a formal report of the procedure from permanent images recorded, then the radiologist should use the code for the anatomy studied to code for the interpretation. Note that the media upon which the images are recorded is irrelevant.

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