December 31, 2003

ACR Radiology Coding Source™ November-December 2003 Q and A

Q: How do you code for a radiofrequency ablation of a varicose veins procedure using ultrasound imaging for guidance and monitoring?

A: Currently there is no code that accurately describes the performance of endovenous radiofrequency ablation therapy using imaging for guidance and monitoring of the ablation. At this time, the appropriate codes to report this procedure are 37799 (Unlisted procedure, vascular surgery) for the endovenous RFA and 76999 [(Unlisted ultrasound procedure (e.g., diagnostic, interventional)] for the guidance and monitoring of the procedure, unless otherwise instructed by your carrier or payer.

Q: How should a study of an MRI of the brain and of the pituitary gland be reported?

A: If both an MRI of the brain and an MRI of the pituitary gland are separately requested and performed with a full series of specialized pulse sequences, specifically of the pituitary gland, then an MRI of the brain should be reported two times with a modifier (e.g. –59) appended to the second study. Note that clear, separate and distinct indications for two complete studies must be documented. If just an additional pulse sequence or two, focused on the pituitary gland, are added to the MRI of the brain, the extra sequences would be considered part of the base study, and an MRI of the brain reported only once.

This is similar to the reporting of an MRI of brain and the internal auditory canal. Reference the March/April 2003 feature article of the ACR Radiology Coding Source™ for further discussion.

Q: A post-operative lung transplant patient has a conventional CT scan without contrast performed to evaluate bronchial anastamosis, the parenchyma, and lymph nodes. During the same session, an inspiration/expiration high-resolution CT scan is performed to look for air trapping and to better evaluate the parenchyma. Is it appropriate to charge for the high-resolution scan separately?

A: If a high-resolution CT of the chest without contrast that consists of more than just a few extra sections (e.g. supine and prone studies in inspiration and expiration at multiple levels) is performed to better evaluate the parenchyma, report code 71250 (CT thorax, without contrast) and append a –22 modifier (services provided are greater than those usually required). It is recommended that a report be submitted to justify the use of the –22 modifier. It is not appropriate to code for the high resolution separately as all three acquisitions are "unenhanced" chest CT exams.

When a few additional sections are obtained as part of a CT of a particular anatomical region, they are included in the initial examination and not coded separately. However, if two studies are performed at two separate sessions and based on two separate orders, it would be appropriate to report both studies. In this case, one of the studies would require a modifier to indicate separate and distinct studies.

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