Radiology Coding Alert

The task of appropriately assigning CPT Codes 's reconstructive view code sometimes trips up radiology coders who forget how to use these pivotal add-on codes.

According to Stacie L. Buck, RHIA, compliance officer for U.S. Diagnostic Inc., a corporation in West Palm Beach, Fla., that owns and operates diagnostic imaging centers in several states, confusion about 76375 (Coronal, sagittal, multiplanar, oblique, 3-dimensional and/or holographic reconstruction of computerized axial tomography, magnetic resonance imaging, or other tomographic modality) can be erased by keeping the following tips in mind.

1. Understand what a reconstructive view is. Code 76375 describes computer-generated enhancements conducted after a diagnostic imaging study has been completed, says Patti Offner, RT, with Diagnostic Imaging Inc. in Philadelphia. "After images are taken, they are reformatted in a different projection using special software. It is an additional step beyond the basic procedure and is performed by the radiologist to further define an area of interest." Original CT, MRI, positron emission tomography (PET) or single photon emission computed tomography (SPECT) images are manipulated to reveal additional and different views that may expose an abnormality or anatomic relationship not easily seen on the original images or projection.

Reconstruction views may include:

2. Recognize that 76375 is an add-on code. Many coders mistakenly report a reconstructive view by itself, Offner says. However, it must be reported with the proper modality and anatomic site. A radiologist may perform a CT of the cervical spine, for instance, with reconstruction in the sagittal plane on a trauma case. Coders may report both a cervical spine CT code (e.g., 72126, Computerized axial tomography, cervical spine; with contrast material) and 76375.

3. Don't confuse views inherent in the original study with reconstructive images. The views listed in the reconstruction code descriptor (e.g., sagittal or coronal) may also be directly obtained during the basic study itself, Buck says. For instance, a coronal view may be standard acquisition during a CT scan. Therefore, references to these views in the radiology report do not automatically indicate that reconstruction took place. They may simply reflect the planes in which images were generated. To justify the addition of 76375, the radiologist must have reformatted the images after the scan to create the additional view noted (e.g., axial or sagittal views were reconstructed subsequent to the original coronal view being obtained).

4. Read the radiologist's documentation carefully. "To substantiate a claim with 76375, the radiologist's report must clearly state that reconstruction was done," Buck says. "The words 'reconstructive views' or 'reconstruction' must appear." A simple reference to coronal, sagittal, etc., is not enough because these views may be obtained through the diagnostic study itself. In addition, she says, sometimes the radiologist's documentation will note that "MRI with MPR" was conducted. "The MPR would refer to multiplanar reconstruction, so the add-on code could be reported."

Coding experts also report that medical necessity has become a growing issue for many payers when reconstructive views are obtained. Some practices have begun performing reconstructions as a matter of protocol, but most insurers do not accept this practice. The radiology report must document medical necessity, and coding consultants advise radiologists to include language stating, for instance, that "coronal and sagittal reconstructions were performed in an effort to accurately visualize ..." and refer to the specific organs or structures being studied.

Coding tip: Alert radiologists to the fact that their reports must make specific reference to "reconstruction" and that these views must be medically necessary in order for code 76375 to be reported.

5. Recognize that 76375 should never be reported with CTA or MRA. Computed tomographic angiography (CTA) and magnetic resonance angiography (MRA) are less invasive methods for imaging vessels that have gained widespread acceptance in recent years (e.g., 70496, Computed tomographic angiography, head, without contrast material[s], followed by contrast material[s] and further sections, including image post-processing). "Coders should recognize that two- and three-dimensional reconstructions are inherent in these studies," Offner says. "The code description already refers to the procedure (i.e., image postprocessing); the add-on code would not be used."

Case Studies

CT Scan of the Paranasal Sinuses

History: Recurrent or frequent sinus infections
Coronal high-resolution scans were obtained through the paranasal sinuses. This reveals mild to moderate mucosal thickening in the left maxillary antrum. There is a 2-cm polypoid soft-tissue-density structure in the anterior aspect of the left maxillary antrum, which is consistent with a retention cyst or polyp. There is mild mucosal thickening in the ostium and infundibulum on the left side.

There is mild to moderate mucosal thickening in the right maxillary antrum. There is a 1-cm polypoid soft-tissue structure in the anterior aspect of the right maxillary antrum consistent with a retention cyst or polyp. There appears to be occlusion of the ostium and infundibulum on the right by the mucosal thickening.

Sphenoid air cells appear normal. Areas of moderate mucosal thickening are present in the ethmoid air cells bilaterally. Frontal air cells appear normal. Otherwise no significant findings are noted.

Coding: Report only 70486 (Computerized axial tomography, maxillofacial area; without contrast material). Even though the report references "coronal," this view was obtained during the CT itself and no references to reconstruction are contained in the report.

CT Right Foot

Indication: Neuropathic arthropathy

Spiral images were obtained and displayed at 3-mm intervals. Coronal and sagittal reconstructions were also performed.

There is severe bone demineralization. There is a fracture through the proximal shaft of the second metatarsal. There is not complete osseous union at the fracture site. The fracture margins are sclerotic. There is severe osteoporosis. There is mild to moderate sclerosis involving most of the tarsals in the mid foot. No acute fracture is detected.

Impression: Mixed lysis and sclerosis in the midfoot consistent with the clinical diagnosis of neuroarthropathy.

Ununited fracture through the base of the second metatarsal.

Coding: Report both 73700 (Computerized axial tomography, lower extremity; without contrast material) and 76375. Note the explicit reference to reconstructions in the radiology report.

(Radiology reports provided by Stacey Hall, RHIT, CPC, CCS-P, director of corporate coding for Medical Management Professionals Inc., a national billing and management firm for hospital-based practices in Chattanooga, Tenn.)