October 31, 2011

ACR Radiology Coding Source™ for September-October 2011 Q and A

Q: What CPT code should be used to report a lumbar CT performed after discography?  Is a CT scan post-discography considered a ‘with contrast’ study?

A: The correct CPT code to report a post-discography lumbar CT study is 72131 (Computed tomography, lumbar spine; without contrast material.  The CPT®codebook introductory guidelines, p. 361 of the professional edition, Administration of Contrast Material(s), states The phrase “with contrast” used in the codes for procedures performed using contrast for imaging enhancement represents contrast material administered intravascularly, intra-articularly or intrathecally.”  Therefore, intradiscal administration of contrast does not meet the requirement to report a “with contrast” CT study.

Q: Is it appropriate to report the intra-operative ultrasound CPT® code 76998 in conjunction with a renal angioplasty when the physician uses ultrasound guidance in the OR to access the vessel?

A: No, it is not appropriate to report CPT® code 76998 (Ultrasound guidance, intra-operative) to report the ultrasound guidance used for vascular access when the guidance is performed in the operating room (OR).  The appropriate code to report ultrasound guidance to achieve vascular access is 76937 (Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent real-time ultrasound visualization of vascular needle entry, with permanent recording and reporting (List separately in addition to code for primary procedure). 

Per the ACR’s Ultrasound Coding User’s Guide 2010, code 76998 is used when ultrasound is utilized in the operating room by the surgeon or ultrasonologist.  It is appropriate to report 76998 once, when all the imaging is in the same operative field.  If there are several operative fields, report the code per operative field.  Providers should recognize that individual payers may limit coverage in such circumstances.