ACR Radiology Coding Source™ May-June 2005 Q and A

Q: Question: Should the telemedicine codes be used alone or in conjunction with radiology codes to report radiology services performed via tele-imaging or teleradiology?

A: No, telemedicine codes should not be used as stand-alone codes or in conjunction with radiology codes to report any teleradiology or tele-imaging service performed.

Formal complete imaging interpretation and reporting services are excluded from any telemedicine services. When formal imaging interpretation and reporting services are provided either on-site or remotely (the latter using established tele-imaging standards), such services are appropriately described by the existing radiology CPT® codes. For example, the formal interpretation of any chest x-ray is appropriately reported by one of the radiologic examination codes 71010, 71015, 71020, etc.

The Medicare Benefit Policy Manual, Chapter 15, Covered Medical and Other Health Services, Section 270.2 identifies telemedicine services as:

Consultations – CPT® codes 99241-99275
Office or other outpatient visits – CPT® codes 99201-99215
Individual psychotherapy - CPT® codes 90804-90809
Pharmacologic management - CPT® code 90862
Psychiatric diagnostic interview examination – CPT® code 90801
End stage renal disease related services - HCPCS codes G0308, G0309, G0312, G0314,G0315, G0317, and G0318

Q: One of the components required for reporting a complete OB ultrasound for gestational age less than 14 weeks (76801) is a "survey of placental anatomic structure." However, the placenta cannot be distinguished on ultrasound until around the tenth week of gestation. Would documentation of measurement and shape of the gestational sac serve as the requirement for "survey of placental anatomic structure" performed at 9 weeks or should the limited procedure code 76815 be assigned?

A: It is appropriate to code for the complete OB ultrasound study (76801) even though a survey of the placental anatomic structure was not performed. However, the radiologist must note in his dictation that a survey of placental anatomic structure could not be performed because of gestational age. As noted in the CPT 2005 code book introductory notes prior to the diagnostic ultrasound codes: "For those anatomic regions that have 'complete' and 'limited' ultrasound codes, note the elements that comprise a 'complete' exam. The report should contain a description of these elements or the reason that an element could not be visualized (eg, obscured by bowel gas, surgically absent, etc.)."

Q: In the Jan/Feb 2005 ACR Radiology Coding Source™ feature article, the ACR recommended use of the unlisted CT code (76497) to report coronary CT angiography. Others have recommended using the CT Angiography Chest code for coronary CTA (71275). Do I risk being considered noncompliant if I use 71275?

A: Pending creation of a new code, the ACR's position is that, unless a specific payer has advised otherwise (some private payers are requesting use of the temporary HCPCS code S8093), the new work of coronary CT angiography should be reported using the unlisted computed tomography procedure code (76497).

According to the CPT coding guidelines (p. xiii, CPT 2005 code book) you should "select the name of the procedure or service that accurately identifies the service performed. Do not select a CPT code that merely approximates the service provided. If no such service exists, then report the appropriate unlisted procedure/service code."

As noted in the Jan/Feb 2005 ACR Radiology Coding Source™, the typical acquisition and postprocessing protocols used for CTA of the chest are for pulmonary embolism or aortic dissection, which do not supply the information needed for exclusion of coronary artery occlusive disease. Acquisition and postprocessing algorithms dedicated to evaluation of coronary vessels are used instead of those employed for a conventional CTA of the chest examination. The CT techniques for high-quality coronary CTA are vastly different from the examinations described by 71275 with respect to field of view, slice thickness, gating requirements, reconstruction algorithms, and even scanner requirements. Therefore, since the coronary CTA is not accurately described by CTA of the chest, it would not be appropriate to report code 71275.

New Category III codes will take effect in January of 2006. Look for updates to the coding of coronary CTA in the July/August ACR Radiology Coding Source™.