Radiology Coding Alert

How well do you know the radiology CPT^® codes?

After you’ve answered the quiz questions on page 3, compare your answers with the ones provided below:

Answer 1: A. CPT^® code 72040 (Radiologic examination, spine, cervical; 2 or 3 views) is the correct answer for this scenario. The radiologist used X-rays to capture 3 distinct views of the C1-C7 vertebrae, including the C7-T1 junction, which make up the cervical spine.

While the descriptors for 72050 (…; 4 or 5 views) and 72052 (…; 6 or more views) indicate a cervical spine exam, the distinct number of views is the difference. You’ll use 72050 when the radiologist performs four or five views that include the seven neck vertebrae, the 1st vertebrae of the thoracic spine, and the disk spaces in between. If the radiologist captured six or more views, such as those covered with code 72050, as well as possible views from an angled position and with extension and flexion movements, then you’ll use 72052.

You’d use 72020 (Radiologic examination, spine, single view, specify level) to report a single view of the spine. According to the descriptor, the order should include which area of the spine the radiologist images — cervical vertebrae, thoracic vertebrae, lumbar vertebrae, or sacrum and coccyx.

Answer 2: C. As the radiologist has detailed the CT scan, thoracic vertebrae, and dye injection in the op note, you can conclude the answer is 72129 (Computed tomography, thoracic spine; with contrast material). Synonyms that also indicate contrast material include contrast medium, contrast media, and contrast agent. Additionally, code 72128 (…; without contrast material) is a close match, but the end of the descriptor is the main difference.

If the documentation indicates the radiologist initially performed the CT scan without contrast, then administered contrast and performed additional scans to make a diagnosis, then you’d use 72130 (…; without contrast material, followed by contrast material(s) and further sections).

CPT^® code 72126 (Computed tomography, cervical spine; with contrast material) is for reporting a CT scan of the cervical spine, so that code doesn’t fit the scenario.

Answer 3: C and D. For this scenario, you will use 76882 (Ultrasound, limited, joint or other nonvascular extremity structure(s) (eg, joint space, peri-articular tendon[s], muscle[s], nerve[s], other soft-tissue structure[s], or soft-tissue mass[es]), real-time with image documentation) to document the ultrasound of the knee. The use of “limited” in the descriptor indicates this code should be used when the procedure is performed on a specific structure within the extremity, which in this case are the ligaments, tendons, and cartilage.

Code 76881 (…, complete joint (ie, joint space and peri-articular soft-tissue structures), real-time with image documentation) is a complete ultrasound of the area, which involves examining the tendons, muscles, nerves, and soft tissue.

Both 73721 (Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material) and 73718 (…, lower extremity other than joint; without contrast material(s)) represent MRI procedures without contrast. The crucial piece of information is where the procedure occurred. You’ll use 73718 for a “lower extremity other than [a] joint,” which includes the thigh, lower leg, or foot. The descriptor for code 73721 calls out “any joint of lower extremity,” which covers the hip, ankle, or knee.

73721 modifier notes: You may need to alter the way the service is identified as bilateral. You could list the applicable code twice on the claim and append each instance with LT (Left side) and RT (Right side) modifiers. You could also report a single line item and report two units, this is because modifier 50 (Bilateral procedure) is not appropriate for bilateral radiology procedures. However, you should check individual payer guidelines for the correct way to bill in this situation.

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