Radiology Coding Alert

• “Thin cut axial images were obtained during the administration of non-ionic iodinated IV contrast. Coronal and sagittal thin and thick slice MIP and 3D reformatted images were also generated.”

To drive the point home, have a look at one more technique of a CTA with contrast that meets all the necessary requirements for 3D rendering using slightly different terminology:

• “Axial images are obtained after contrast administration. Coronal and sagittal reconstructions were performed. 3D MIP and volume rendered reconstructions were performed at a separate workstation. An AEC protocol was utilized.”

Rely on Workstation Documentation for Separate 3D Codes

FAQ: Does a workstation need to be documented in a CTA report?

Since 3D interpretation is included in a CTA, you don’t need documentation of the use or non-use of an independent workstation. Documentation of a workstation is necessary when making the distinction between 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) and 76377 (…requiring image postprocessing on an independent workstation). While the use of a separate workstation for 3D rendering of a CTA is possible, it’s more often that one workstation will include 2D and 3D capabilities.

“Nowadays, you’ll find many radiological workstations allow for 3D rendering without the need for an independent workstation,” says Barry Rosenberg, MD, chief of radiology at United Memorial Medical Center in Batavia, New York. “This means you’ve got one workstation that has 3D rendering capability in addition to visualizing plain 2D X-rays,” explains Rosenberg.

Have a look at one more technique from a dictation report that meets all the necessary requirements for 3D rendering in a CTA without the documentation of a workstation:

“CT of the chest is performed with multi-planar reconstructions per PE protocol after the uneventful intravenous injection of IV contrast. Additional maximum intensity projection (MIP) 3D post contrast images of the chest were reviewed.”

Code 3D Postprocessing on Separate Days

FAQ: Does the 3D reconstruction need to be performed on the same date as the underlying imaging study?

While you won’t typically encounter too many instances where the radiologist performs 3D rendering of a particular study one day or more following the base study, the provider is still eligible to submit a 3D reconstruction code to the payer. CPT^® Assistant (October 2019; Volume 29: Issue 10) further elaborates that codes 76376 and 76377 “are appropriate for reporting 3D-rendering services provided on a date separate from the base-imaging study.”

For a better understanding of how this scenario may play out in real-time, consider the following example addendum dictation report involving 3D post-processing one day following the base study:

“3D volume-rendered reconstructions were performed using source images from the patient’s right foot CT without contrast from the original date of service (DOS). These were performed at a separate workstation. The findings are discussed in the original CT report (accession number).”

In this instance, you’d have enough documentation to support code 76377 submitted on the DOS that the radiologist performed the 3D post-processing. However, keep in mind that documentation supporting the 3D reconstruction for a CTA should not be included in a separate dictation report.

Abstain From Coding 77080 Postprocessing Separately

FAQ: Can a 3D rendering code be used in conjunction with a dual energy X-ray absorptiometry (DEXA) scan code?

This question was recently addressed in CPT^® Assistant (September 2019; Volume 29: Issue 9). While no National Correct Coding Initiative (NCCI) edits are in place to bundle or prevent coding of 77080 (Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)) with 76376 or 76377, you should not consider the use of any post-processing software to determine trabecular bone score (TBS) as meeting the criteria for either respective 3D rendering code.