MRI always involves “localizer” scans to prescribe any scans, contrast or not. These are generally of limited diagnostic value although usually archived and reviewed as part of the exam. Consequently, no MRI or MRA scans are ever truly done “with contrast” only as they all have at least these (noncontrast) localizers built in. If only localizer scans are done pre-contrast and the bulk of the diagnostic imaging is done only after contrast administration, would that constitute a “contrast only” MRI/MRA scan? In other words, would a “non-contrast followed by contrast scan” code only apply if additional imaging beyond localizers was done after contrast?
It is not appropriate to report a non-contrast study of any type (CT or MR) based on localizer images only. Counting the localizer noncontrast images as sufficient for coding purposes as a noncontrast portion of a "without and with contrast" exam would be inappropriate in the absence of diagnostic sequences performed prior to contrast administration. Specifically, the localizer images are not meant to be used as a non-contrast portion of the examination and should not be coded as such.
Do beneficiary coinsurance and deductible apply to claim lines with 77063 (Screening digital breast tomosynthesis, bilateral [List separately in addition to code for primary procedure])?
No, beneficiary coinsurance and deductible do not apply to claim lines with 77063 (Screening digital breast tomosynthesis, bilateral [List separately in addition to code for primary procedure]). The Centers for Medicare & Medicaid Services (CMS) looks at code 77063 only in terms of it being a screening mammogram procedure. In addition, code 77063 is an add-on code to the primary procedure. Therefore, 77063 must be billed in conjunction with the screening mammography HCPCS code G0202 (Screening mammography, producing direct digital image, bilateral, all views, 2D imaging only). In accordance with that policy, beneficiary coinsurance and deductible do not apply to claim lines with code 77063.
Assuming that the reading physician provides all of the necessary documentation criteria, can we charge 76376 or 76377 in addition to the primary procedure for 3-D reconstruction of AP and Lateral X-ray images? All reconstruction performed 100 percent of the time on-site.
It is appropriate to report the CPT X-ray code for the body part being examined.
CPT codes 76376 (3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; not requiring image post-processing on an independent workstation) or 76377(3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; requiring image post-processing on an independent workstation) by their definition require that the original imaging be performed via computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality. The two-view planar x-ray image acquisition as described does not fit into any of these categories and thus the reporting of either of these CPT codes is not appropriate. It would be appropriate, however, to report the increased procedural services modifier (-22) for the additional work of generating and interpreting the reconstructions, if the site wishes to do so.
Does ACR have a recommendation for coding of percutaneous core biopsy of an ovary?
It is the consensus of the Economics Committees on Coding and Nomenclature and Interventional Radiology that it is appropriate to use CPT code 49180 (Biopsy, abdominal or retroperitoneal mass, percutaneous needle) plus the appropriate guidance code for the reporting of a percutaneous core biopsy of an ovary.