Radiology Coding Alert

Don't panic: We've got the truth behind this 'no indications for contrast' puzzle If you crave feedback on your coding skills without the hassle of denials and audits, here's your chance. Try your hand at this CT report, and then see whether your answers match the pros'.
Lock in Your Code Choices Start by analyzing the following report from an imaging center, and decide which CPT, ICD-9 and HCPCS codes you would report on the center's global service claim. Exam: CT neck with contrast Indication: Left vocal cord paralysis Technique: Axial CT cuts were obtained from the top of the orbits down to the thoracic inlet using 100 cc of Isovue 300. 1.3-mm axial CT cuts were also obtained through the larynx. Sagittal and coronal computer reconstruction images were also obtained. Indications for use of non-ionic contrast: None reported Findings: No mass lesion within the posterior nasopharynx or oropharynx. There are multifocal punctuate calcifications in the right palatine tonsil. The submandibular and parotid glands are unremarkable. There are subcentimeter anterior cervical and left submandibular lymph nodes. There are subcentimeter left internal jugular lymph nodes. The left pyriform sinus is slightly larger than the right, and there is dilatation of the left laryngeal ventricle. There is probably atrophy of the left true vocal cord best seen on the 1.3-mm thick images. The left arytenoid cartilage has a more medial position than the right. The thyroid glands are unremarkable. The visualized upper mediastinum is unremarkable. Impression: 1) Left vocal cord paralysis, 2) No cervical mass or adenopathy.

Size Up Your CPT Solution For this exam, you should report 70491 (Computed tomography, soft tissue neck; with contrast material[s]), says Stacie L. Buck, RHIA, CCS-P, LHRM, RCC, vice president of Florida-based Southeast Radiology Management and president of Florida HIM Association. You can't automatically depend on the "Neck CT with contrast" header to choose your code, but the report describes neck anatomy and intravenous contrast, confirming that the neck CT with contrast code is correct. Remember: You should never choose a code based on the report's header, says Sheldrian Leflore, BA, CPC, revenue management educator with California-based The Coding Group. You need to base your choice on the report documentation, she says. Beware: The report says that "sagittal and coronal computer reconstruction images were also obtained." You should not report 76376-76377 (3D rendering with interpretation and reporting of computed tomography ...) because converting an axial scan into the coronal or sagittal plane is 2D reformatting. CPT guidelines specify that you may not report 2D formatting separately.
Follow These ICD-9 Accuracy Tips
You'll have to overcome a few obstacles to choose the most accurate diagnosis code for this service, which includes the finding of "left vocal [...]