Otolaryngology Coding Alert

Consider contrast billing rules for office versus facility.

With more otolaryngology practices beginning to incorporate in-office computed tomography (CT) scanning, it’s imperative that coders for these respective practices are well-versed on all the essential coding mechanics needed to code these scans. “While the only imaging my providers currently offer is ultrasound guidance (US) for fine needle aspirations (FNAs), in-office dynamics of otolaryngology practices are constantly changing — and it’s important to be prepared accordingly,” relays Kimberly Quinlan, CPC, senior medical records coder for the University of Rochester Medical Center’s Department of Otolaryngology in Rochester, New York.

Historical context: “Many otolaryngology practices have actually been performing maxillofacial CT scans in their office for the last 15 years,” says Barbara J. Cobuzzi, MBA, CPC, COC, CPC-P, CPC-I, CENTC, CPCO, of CRN Healthcare in Tinton Falls, New Jersey. “In fact, there’s even a MiniCAT™ by Xoran Technologies that works as a single-function CT scanner that looks very similar to a dentists’ panoramic X-ray machine,” Cobuzzi explains.

From a coding perspective, there are more than a few considerations to take into account if you’re working on a CT scan of the ears, maxillofacial area (sinuses), neck, or any other clinically relevant anatomic site in need of imaging. These include anatomic site, component modifiers, contrast, and a wealth of authoritative guidance.

Read on to break down some of these integral coding concepts for in-office CT scans.

Break Down Dynamics Behind TC, PC Modifiers

Before diving into any CPT^® or HCPCS coding considerations, you want to make sure you’ve grasped the concept of technical versus professional component. When it comes to diagnostic radiology, you’ve got to know when to bill the respective technical or professional component — or when to bill for it globally. The professional component of a diagnostic radiology service involves the radiological supervision and interpretation (RS&I) of a given scan. The technical component is reserved for facilities that own imaging equipment, but don’t partake in the RS&I. In most circumstances involving hospital settings, the hospital will bill for the technical component, and radiologists contracted with the hospital will bill for the professional component.

Note: Keep in mind that some otolaryngologists may own the equipment and opt to perform the supervision and interpretation portion of the exam, in which case you may bill globally.

In order to bill for each respective component, a modifier is appended to the CPT^® code for the imaging service. These modifiers are outlined as TC (Technical Component) and 26 (Professional Component). For an applicable imaging service, both the facility and the provider will append modifiers TC and 26, respectively, to individual claims under their own National Provider Identifier (NPI).

Home in on Contrast Billing, Administration

Outside of anatomic site, there’s one crucial detail you’ve got to identify in order to reach the correct CPT^® code: contrast. When a CT scan is performed with contrast, there should be documentation of the provider administering contrast via one of the following methods:

• Intravascular
• Intraarticular
• Intrathecal

For the purposes of imaging performed in an otolaryngology practice, contrast will typically be administered intravascularly. Furthermore, the administration of contrast is an inclusive component of the respective CPT^® code.

However, while the administration is not separately billable, it’s important to keep in mind that a provider may bill for contrast imaging agents when the scan is performed in an office setting. Your provider will typically be injecting low osmolar contrast as described by one of the following HCPCS codes:

• Q9965 (Low osmolar contrast material, 100-199 mg/ ml iodine concentration, per ml)
• Q9966 (Low osmolar contrast material, 200-299 mg/ ml iodine concentration, per ml)
• Q9967 (Low osmolar contrast material, 300-399 mg/ ml iodine concentration, per ml)

Consider a scenario where a patient receives a CT scan with contrast and the provider injects 150 ml low osmolar contrast. In addition to the CT scan code, you’ll report Q9965 x 150 units.

Choose Carefully Between This Set of Code Ranges

The last piece of the puzzle is aligning the correct CPT^® codes with the anatomic site imaged. Fortunately, this is a relatively straightforward process. You’ll typically be considering one of three codes for an imaged anatomic site: without contrast, with contrast, and with and without contrast.

Within the scope of otolaryngology, you’ll primarily be working within the confines of the following CT scan codes:

• 70480-70482 (Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear…)
• 70486-70488 (Computed tomography, maxillofacial area…)
• 70490-70492 (Computed tomography, soft tissue neck…)

Code range 70480-70482 outlines a few anatomic sites in the code description, but that’s not the full story. For instance, it’s important to know that the sella (or sella turcica) includes imaging of the pituitary gland. Furthermore, code range 70480-70482 is also reported for imaging performed on the temporal bones.

You can see that the code description isn’t as generous when it comes to code range 70486-70488. A maxillofacial CT involves imaging from the maxillary sinuses to the frontal sinuses. This code range may also include imaging of the nasopharynx and the oropharynx so long as there is documentation that the study is expanded to include those sites.

Finally, code range 70490-70492 involves, as the code description states, imaging of the soft tissue of the neck.

However, imaging of the larynx may be included in this code, as well. Just keep in mind that similar to code range 70486-70488, documentation must support the respective anatomic site imaged.