Question: ACR has previously clarified in the December 2018 issue of Coding Source that it is appropriate to code a “with contrast” spine when the spine is reconstructed from a body computed tomography (CT) acquisition that was performed with contrast. For example, original scan such as CT Chest w/contrast (71260 and CT Abdomen & Pelvis w/contrast 74177. A question has been raised if this is still correct when only the bone windows of the reconstructed spine are interpreted, since the IV contrast is not evident as in the soft tissues window. The reconstructed spine will be interpreted by a neuroradiologist. The soft tissues with contrast on the original body CT scans are interpreted by another radiologist. I would like to confirm that 72129 CT Thoracic Spine with contrast and 72132 CT Lumbar Spine with contrast is appropriate for the professional component (-26 modifier).
Answer: The window and level settings used to review the CT images do not determine the CPT code selection. When the base body CT code is performed with IV contrast (eg, 71260), then the respective reconstructed spine CT with IV contrast (72129 with -26 modifier) should be reported. Similarly, when the base body CT code is performed without IV contrast (eg, 71250), then the respective reconstructed spine CT without IV contrast (72128 with -26 modifier) should be reported.
The anatomic area scanned and whether the scan is performed without, with, or with and without intravenous contrast, should all be clearly described in the dictated report. Based on the provided report, it is not possible to assign a CPT code correctly. Specifically, the dictation does not specify whether contrast was used. This information is necessary for the selection of the correct CPT code for the reconstructed CT and should be included in the reports for both the base CT procedure and reconstructed spine CT.