Otolaryngology Coding Alert

Question: My otolaryngology practice recently bought a mini CT scan device and started performing CT scans of the sinus without contrast. Which CPT code should we report for this service? Also, can I include a separate code for the surgeon's work reading the scan?

Wisconsin Subscriber

Answer: You should report 70486 (Computed tomography, maxillofacial area; without contrast material) for the CT scan. The reimbursement for 70486 includes both the technical component (the work performing the scan) and the professional component (the physician's work interpreting/reading the scan). If your practice owns the CT scan device, an employee performed the scan, and the ENT interpreted the study, you should report 70486 only.

On the other hand, if you performed the CT scan and then hired a radiologist to do the interpretation, you should report 70486-TC (Technical component) only, because the radiologist will bill 70486-26 (Professional component).

Some payers require that a radiologist perform and bill the interpretation. Keep in mind: Some practices always use a radiologist to do the overreads even if the payer does not require it, for a higher level of quality control and compliance.

Important: Code 70486 is inherently bilateral, so you should report 70486 once even if the ENT studies sinus cavities on both sides.