April 30, 2004

ACR Radiology Coding Source™ Mar-Apr 2004 Q and A

Q: With the implementation of new Category III codes as of July 1, 2004, how should a CTC be coded when it is performed following a failed screening colonoscopy due to obstructing lesion? Should this be reported as a screening or diagnostic procedure?

A: Although the indication for the colonoscopy was for screening purposes, the indication for CT colonography is for a known obstructing lesion and, therefore, should be coded as a diagnostic CT colonography study. As of July 1, 2004, the code used to describe a diagnostic CTC is 0067T.

If the indication for CT colonography were for screening purposes, the screening CTC code (0066T) should be reported even if a positive finding may be found on CTC. The positive finding may be reported as a secondary diagnosis.

Section IV, Diagnostic Coding and Reporting Guidelines for Outpatient Services, of the ICD-9-CM Official Guidelines for Coding & Reporting (http://www.cdc.gov/nchs), as provided by the Centers for Medicare and Medicaid Services and National Center for Health Statistics (developed and approved by the American Hospital Association, the American Health Information Management Association, CMS and NCHS), has been clarified in Program Memorandum AB-01-144 (E),

When a diagnostic test is ordered in the absence of signs/symptoms or other evidence of illness or injury, the physician interpreting the diagnostic test should report the reason for the test (e.g., screening) as the primary ICD-9-CM diagnosis code. The results of the test, if reported, may be recorded as additional diagnoses.

Q: Is it appropriate to use code 76937 (ultrasound guidance for vascular access) with a –52 modifier if permanent images are not recorded?

A: No, it is not appropriate to report 76937 (ultrasound guidance for vascular access…) with a –52 (reduced services) modifier if permanent images are not recorded. The descriptor specifies “…with permanent recording and reporting…”. As noted in the ACR Radiology Coding Source™ Nov/Dec 2003 issue, “A permanently recorded image for guidance (U/S and/or fluoroscopy) is required.”

The AMA’s CPT®Changes – An Insider’s View, 2004, also notes:

“…Use of code 76937 requires a permanent recorded image(s) of the vascular access site to be included in the patient record, as well as a documented description of the process either separately or within the procedure report.”

Q: What are the appropriate codes to use for two PA chest x-rays performed on inspiration and expiration postlung biopsy, or for trauma cases?

A: When two PA chest x-rays are performed, one on inspiration and one on expiration, it is appropriate to code 71010 (chest, single view) for the single, frontal chest inspiration view, and 71035 (chest, special views [e.g., lateral, decubitus, Bucky studies]) for the expiration view. The expiration view of the chest is considered a special view.

If a PA and lateral chest x-ray were performed on inspiration and expiration, it would be appropriate to report 71020 for the two views of the chest on inspiration, and 71035 for the two views of the chest on expiration.