October 31, 2013

ACR Radiology Coding Source™ September-October 2013 Q and A

Q: A urologist utilizes a workstation independent of the ultrasound system when performing a prostate biopsy to create a three-dimensional (3D) model of the prostate from the ultrasound images. This is used to assist with biopsy locations and also to generate a report noting the location within the prostate for each biopsy taken. The system also stores information for future procedures if necessary. Is code 76377 the appropriate code to report the use of this system in addition to ultrasound code 76942?

A: No, code 76377, 3D rendering with interpreta­tion and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image post-processing under concurrent supervision; requiring image post-processing on an independent workstation,  should not be reported in addition to 76942, Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation,  to describe the use of a separate workstation to create a three-dimensional (3D) model of the prostate from the ultrasound images. 
Three-dimensional reformats from sectional imaging modalities, such as computed tomography and magnetic resonance imaging are created off-line and after the image acquisition. Conceivably, two-dimensional (2D) ultra­sound images could be transferred off-line for 3D reformats, but this would require a mechanical rather than a hand-held scanner for positional image registration. Codes 76376 and 76377 describe 3D complex reformatting, which includes shaded-surface rendering, volumetric rendering, maximum intensity projections, fusion of images from other modalities, and quantitative analysis.

Q: The bundled code 37210 for uterine fibroid embolization (UFE) is to be deleted in 2014.  What code should be reported in 2014 to describe an elective UFE procedure?

A: Code 37243, (Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction) will replace 37210 in 2014 to describe an elective embolization of the uterine arteries to treat uterine fibroids.  
Key to determining the appropriate embolization code is the indication for the study.  As noted in the CPT® 2014 guidelines, Code 37243 is used to report embolization for the purpose of tissue ablation and organ infarction or ischemia. This can be performed in many clinical circumstances, including embolization of benign or malignant tumors of the liver, kidney, uterus, or other organs…
There may be overlapping indications for an embolization procedure. The code for the immediate indication for the embolization should be used. For instance, if the immediate cause for embolization is bleeding in a patient with an aneurysm, report 37244.  Therefore, in an emergency situation to control uterine artery hemorrhage, it is appropriate to report 37244.
Note that the codes for catheter placement, ultrasound for vascular access, and imaging for diagnostic studies may be reported separately with the appropriate modifier (eg, 59) to designate separate and distinct procedures.