October 31, 2003

ACR Radiology Coding Source™ September-October 2003 Q and A

Q: How do you code for CT-guided radiofrequency ablation of a kidney tumor?

A: Currently, there is no CPT® code to describe a radiofrequency ablation of a kidney tumor; therefore, it is recommended that the unlisted procedure code 53899 be used. The CT guidance associated with the kidney tumor ablation would be coded 76362 (CT guidance for, and monitoring of, tissue ablation). CPT® codes are also available to describe guidance for, and monitoring of, tissue ablation when performed with MR (76394) and ultrasound (76490).

Please note that in the CPT® 2004 manual there is a revision to the descriptors of the ablation guidance codes. The descriptors have been updated to specify "...guidance for and monitoring of visceral tissue ablation." Also new for 2004 is a CPT® code to describe radiofrequency ablation of bone tumors. See the November/ December ACR Radiology Coding Source™ for a more detailed discussion of the new 2004 codes.

Q: How do you code for a CTA of the coronary arteries and CT for heart wall thickness, ejection fractions and stroke volumes? Essentially, we perform two different studies: 1) a CTA of the coronary arteries; and 2) a CT heart for wall thickness, ejection fractions, and stroke volumes, as well as other information. Each test is separate and distinct from the other and can be performed alone or at the same time. If performed at the same time, we scan them once and use the same data set for both parts. However, they will be ordered and performed together the majority of the time. How should this be coded?

A: When a study of the coronary arteries and imaging of the heart for wall thickness, including ejection fractions and stroke volumes, is performed, it would be appropriate to code for a CTA of the chest (71275) with the addition of a –22 modifier to indicate unusual procedural services above and beyond that which is ordinarily performed. A CT of the thorax should not be coded. Just as a dedicated splenic CTA would be a CTA of the abdomen, a targeted CTA of the coronaries would be CTA of the chest. Likewise, interpretation of a CTA of the abdomen includes interpretation of the axial data set, and the same is true for CTA of the thorax. It is not appropriate to code for a 76375 for reconstruction, because the 3-D work is included in the CTA code. Currently a code does not exist for the ejection fraction work of this procedure; therefore, it is recommended that the –22 be used in addition to the CTA code, with an appropriate increase in charges to reflect the extra work.

Please reference the May/June ACR Radiology Coding Source™ for a discussion of CTA and when it is appropriate to code for both CT and CTA.

Q: Are there any qualifiers to the use of the CPT code 76010 (Radiologic examination from nose to rectum for foreign body, single view, child)? How do you define a child when coding for this procedure?

A: The definition of "child" for the purpose of CPT code 76010 is an operational one, i.e., can the procedure be done on one film? Any child who measures less than 17 inches from nose to rectum and, thereby, fits on a single 14 x 17 inch film would fit the definition of "child" for this study. Since the descriptor specifically states "one view," one could argue that the entire study should be able to fit on one film. Hence, any child requiring two or more films to evaluate from nose to rectum for a foreign body would be coded as separate one-view chest and abdomen studies.
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