ACR Radiology Coding Source™ for November-December 2011 Q and A

Q: A 3-view C-spine study has been ordered and anteroposterior, odontoid, and lateral views were taken. The tip of the odontoid process could not be visualized on the odontoid view, therefore the technologist repeated the view, but this time a Fuch’s view to show the tip of the odontoid process was obtained. Now, we have a complete series showing all the anatomy. What is the correct code to report the study described above?

A: The appropriate code to report anteroposterior, odontoid, lateral and Fuch’s views is CPT code 72050 (Radiological examination, spine, cervical; minimum of four views), as the Fuch’s view is a uniquely different view and not simply a repetition of the odontoid view. A Fuch’s, also called the occipito-mental view, is a modified frontal view for imaging the tip of the dens (odontoid process).

Q: How is a DaTscan coded?

A: A DaTscan® is the trademark name for I-123 Ioflupane. This radiopharmaceutical agent (approved by the FDA on January 14, 2011) is used in conjunction with Single Photon Emission Computed Tomography (SPECT) imaging to evaluate patients with suspected Parkinsonian syndromes. I-123 Ioflupane is used to determine the location and concentration of dopamine transporters (DaTs) in the synapses of striatal dopaminergic neurons. It is effective in detecting degeneration of the dopaminergic nigrostriatal pathway, thus differentiating patients with essential tremor from those with presynaptic Parkinsonian syndromes. In some cases, it may assist in distinguishing between some causes of Parkinsonism. I-123 Ioflupane is administered intravenously and SPECT images of the brain are obtained 3-6 hours after injection.

CPT code 78607 [Brain imaging, tomographic (SPECT)] is used to report the SPECT images of the brain, and the HCPCS Level II code A9584 (Iodine I-123 Ioflupane, diagnostic, per study dose, up to 5 millicuries) is used to report the I-123 radiopharmaceutical administered.

Q: To report the complete abdominal ultrasound CPT code 76700, CPT requires documentation of eight specific elements, or the reason for non-visualization. Are there specific elements which must be documented in a radiology report to report a complete abdominal CT scan?

A: No, unlike abdominal ultrasound, no specific elements have to be described to report a complete CT study of the abdomen. In many, if not most practices, requests for CT examinations are protocoled and tailored to specific clinical indications. Protocols stipulate what anatomical areas need to be imaged in order to answer the clinical question.

As stated in the ACR Practice Guidelines for the Performance of Computed Tomography (CT) of the Abdomen and Computed Tomography (CT) of the Pelvis, “In general, a CT examination of the abdomen includes transaxial images from just above the dome of the diaphragm to the upper margin of the sacroiliac joints with 5 mm or less slice thickness. In certain cases, it may be appropriate to limit the area exposed and focus only on the area or organs of concern in order to limit the radiation dose. This is especially advised in patients with multiple CT studies and follow-up examinations. The written or electronic request for a CT of the abdomen should provide sufficient information to demonstrate the medical necessity of the examination and allow for its proper performance and interpretation. The accompanying clinical information should be provided by a physician or other appropriately licensed health care provider familiar with the patient’s clinical problem or question and consistent with the state’s scope of practice requirements.”

The same principles apply to CT imaging of other anatomic areas (e.g., chest, pelvis, etc).