Radiology Coding Alert

Learn if contrast is required to report 73206 or 73706.

Providers order computed tomography angiography (CTA) tests to check for several different conditions. Unfortunately, the documentation can be unclear at times.

But building your knowledge of extremity codes doesn’t have to cost you an arm and a leg. All it takes is some familiarity with the extremity CTA codes and some key documentation terms, all of which you’ll find in the following guide.

Know What Needs to be Documented for CTAs

Providers perform CTA scans to evaluate the patient’s blood vessels for aneurysms, arterial blockages, blood clots, and other vascular problems. Look for terms like “CT angiography” or “CTA” in the documentation to identify if the provider performed the scan.

Two codes in the CPT^® code set are designated specifically for CTA scans of the patient’s extremities. You’ll assign either of the following codes depending on which extremity the provider examines:

• 73206 (Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing)
• 73706 (Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing)

However, calling out a CTA in the medical report isn’t sufficient evidence to support reporting 73206 or 73706 for reimbursement. You can assign a CTA code if the documentation is supported by 3D reformatted images.

“3D reformatted images are what differentiates a CT from a CTA. To support a CTA, the radiologist must document everything they normally would for a CT and that the study was performed with 3D post-processing images,” says Kristen R. Taylor, CPC, CHC, CHIAP, associate partner of Pinnacle Enterprise Risk Consulting Services.

While 3D post-processing images are crucial to reporting 73206 or 73706, you cannot report the image processing separately.

Why? 3D post-processing is inherently included in the CTA services, so reporting 76376 (3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; not requiring image postprocessing on an independent workstation) or 76377 (… requiring image postprocessing on an independent workstation) would result in duplicate billing of the service.

Find Out if Contrast Affects Your Code Selection

The descriptors for 73206 and 73706 include, “with contrast material(s), including noncontrast images.”

According to Taylor, this means you’ll report the codes regardless of whether the provider uses contrast during the procedures. “The provider can perform the studies with, without, and/or without followed by with contrast. You’ll assign only one code whether the provider uses or does not use contrast,” Taylor says.

To put this information in perspective, examine the following CTA scenarios:

Scenario 1: A radiologist performs a CTA scan of the patient’s right leg without contrast to evaluate the presence of a blood clot.

Scenario 2: A radiologist performs a CTA scan of the patient’s right leg with contrast to evaluate for the presence of a blood clot.

Scenario 3: A radiologist performs a CTA scan of the patient’s right leg without contrast. After the scan, the radiologist injects contrast material into the patient’s vein and performs another CTA scan of the same leg.

In all three scenarios, you’ll assign only 73706 to report the CTA scan.

Mind the guidelines: The CPT^® guidelines prior to the radiology codes provide instruction on contrast use. According to the guidelines, “with contrast” in a descriptor “represents contrast material administered intravascularly, intra-articularly, or intrathecally.” However, the contrast guidelines later specify that “[i]njection of intravascular contrast material is part of the ‘with contrast’ CT, [CTA], magnetic resonance imaging (MRI), and magnetic resonance angiography (MRA) procedures.”

This means that only intravascularly (IV) administered contrast counts for CTA procedures. Look for the terms “intravascular” or “IV” for indication of the contrast administration with a CTA.

However, as mentioned above, contrast use isn’t a requirement for assigning CTA codes.

Examine This Bilateral CTA Encounter

Scenario: A patient is referred to your radiology practice for CTA scans of both legs. The patient has complained of soreness around the calves and slight swelling, so the patient’s primary care physician (PCP) ordered a CTA of the legs without and with contrast. The radiologist performed CTA scans of the patient’s legs without contrast, then injected IV contrast and performed further CTA scans of the patient’s legs. After the scans, the provider performed 3D post-processing, interpreted the results, and compiled their findings.

To report this scenario, you’ll use 73706 since the radiologist scanned the patient’s legs, but the code doesn’t count for both legs. “Since these codes state ‘extremity’ and we have two upper and two lower, you would code per extremity examined,” Taylor says. In the end, reporting CTA scans for both extremities will come down to your individual payer’s preferences.

You may need to append modifiers LT (Left side), RT (Right side), or 50 (Bilateral procedure) to indicate laterality for the procedure codes.

You’ll choose the most appropriate coding option from the ones below depending on your payer:

• 73706-LT, 73706-RT
• 73706-50

“Depending on the payer, if both extremities are examined by CTA, LT/RT modifiers would be appended to each individual extremity study procedure or bilateral modifier 50 would be appended to a single extremity procedure code,” Taylor adds.