June 30, 2003

ACR Radiology Coding Source™ May-June 2003 Q and A

Q: When is the reconstruction imaging CPT code 76375 used? Are a separate order from the referring physician and a separate report required when reconstruction imaging is provided? What level of documentation should be provided with the use of this code?

A: CPT code 76375 (Coronal, sagittal, multiplanar, oblique, 3-dimensional and/or holographic reconstruction of computerized axial tomography, magnetic resonance imaging, or other tomographic modality) is used to report studies that have been reformatted (reconstructed) from one plane into another (e.g., when images originally taken in the axial plane are reformatted into the coronal plane). Because the reconstruction study is a separate procedure, it should be reported separately from the base study. You should not use 76375 to code for CT imaging procedures originally performed in the coronal, sagittal, multiplanar and or oblique planes.

The usefulness of 2-D, 3-D or holographic reconstructions depends very much on the anatomy being studied, the clinical question and the needs of both the referring physician and the interpreting radiologist. In some exams (complex facial fractures, acetabular fractures, spine pathology are a few examples) reconstruction imaging will legitimately be performed on the majority of the exams. For other studies, such as CT abdomen for pain or metastatic work-up, post-processing will not be used frequently.

When 2-D/3-D or holographic reconstruction is performed on cross-sectional imaging data (e.g. CT, MRI), this should be reported in addition to reporting the original cross- sectional image data. The ACR recommends that this be a separate report or at least a separate section of the total MR/CT report.

The reconstruction code 76375 should not be submitted in addition to the CTA and MRA codes. CT angiography (CTA) and MR angiography (MRA) codes, regardless of the anatomic site, include the post processing (usually maximum intensity projection or surface rendering) of the acquired image data and interpretation of the post-processed images.

A separate order from the referring physician is not necessary to perform reconstruction imaging in a free-standing (nonhospital) facility. The ACR position is that the interpreting radiologist should ultimately decide whether to apply post-processed images, just as he or she decides other technical parameters like slice thickness or whether to use contrast.

Performance of reconstruction imaging will normally fall under the "study design" or protocol of the procedure; however, the interpreting radiologist should explain in the report (separate from the dictation of the original study) why it was necessary to perform the reconstruction. This will both justify "medical necessity," if the report is later reviewed, and inform the physician who ordered the original study what additional information can be gleaned from the reconstructions.

Note that the Ordering of Diagnostic Tests rule does not apply in the hospital (inpatient or outpatient) setting. Hospital facilities are regulated through the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and are covered under HCFA 42 CFR 482.26 (b)(4), Conditions of Participation: Radiologic Services. Medicare’s conditions of participation state, “radiologic services must be provided only on the order of practitioners with clinical privileges, or, consistent with state law, of other practitioners authorized by the medical staff and the governing body to order the services.” Therefore, hospital entities are referred to their medical staff bylaws and state laws for specific regulations as to the ordering of diagnostic tests.

Please direct your questions regarding the material provided in this electronic newsletter to acrrcs@acr.org. The ACR will answer the most frequently asked questions in future newsletters.