Radiology Coding Alert

Know exactly what to look for in your provider's dictation reports.

Sometimes, a referring provider may order 3D rendering alongside an order for a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan. Understanding the various coding and documentation dynamics at play with 3D rendering services can be tricky without a complete understanding of the guidelines.

Keep reading for a full breakdown of the documentation and coding process for 3D reconstruction of CTs and MRIs.

Begin with the Coding Process

Outside of CTA and MRA coding, you will be working with these two 3D rendering codes when appropriately documented by the provider:

• 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
• 76377 - 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; requiring image postprocessing on an independent workstation

When first learning when, where, and how to implement 3D rendering into your coding arsenal, you must have a fundamental understanding of what sorts of procedures you may bill out 76376 and 76377 alongside. Generally speaking, most MRI scans, CT scans, and ultrasounds are eligible for 3D rendering.

When not to Bill 3D

However, there are numerous sets of CPT® codes that you may not report 3D rendering codes with as well. To begin, you should not report 76376 and 76377 with any computed tomography angiography (CTA) scans and magnetic resonance angiography (MRA) scans. As you will see, 3D rendering is included in all angiography scans. Additionally, according to the American Medical Association's (AMA) 2018 Navigator for Diagnostic Radiology, you may not code 3D rendering with the following procedures:

• CT colonography,
• Cardiac CT/CTA,
• Positron emission tomography (PET) scans,
• Nuclear medicine services, or
• X-rays.

Finally, 3D rendering is included in computer-aided detection (CAD) for breast MRIs. When CAD is documented in a breast MRI report, you will include code 0159T (Computer-aided detection, including computer algorithm analysis of MRI image data for lesion detection/characterization, pharmacokinetic analysis, with further physician review for interpretation, breast MRI [List separately in addition to code for primary procedure]).

Memorize these Synonyms

Next, you've got to know how to identify 3D rendering in your provider's reports in addition to differentiating between codes 76376 and 76377. Typically, you will see your provider document something along the lines of "3D rendering with or without an independent workstation," in which case your job simply consists of choosing correct code based on the workstation. However, other scenarios may present themselves in which the provider uses alternate, synonymous terminology to document 3D rendering on a CT, MRI, or ultrasound.

Some other commonly used terms documenting 3D rendering/postprocessing include:

• Maximum intensity projection (MIP),
• Shaded surface rendering, and
• Volume rendering.

On the other hand, terms such as "multiplanar reconstruction (MPR)" and "iterative reconstruction" do not meet the criteria for 3D postprocessing unless used in addition to one of the terms listed above.

To Workstation or not to Workstation

The last piece of the 3D rendering puzzle comes with accurately identifying within the dictation report whether or not the physician utilizes an independent workstation. The provider will need to appropriately document whether or not the radiologist performs the 3D reconstructions on the same scanner as the original study (in which case the scanner is built into the imaging software) or performs them separately on an independent workstation at a later time.

According to CPT^® Assistant (April 2016), the use of an independent workstation means "a separate computer or workstation used for the purpose of three-dimension reconstruction." So, as long as the 3D postprocessing is performed on a separate station from the workstation that processed the 2D images, you may opt for code 76377 which indicates an independent workstation was utilized.

"Providers will typically document the 3D reconstruction and workstation data in the technique of the report," says Barry Rosenberg, MD, chief of radiology at United Memorial Medical Center in Batavia, New York. However, your provider may also report the 3D rendering in the technique and further elaborate on the site of the workstation in the findings – which works just as well.

Tie Rules into CTA Coding

Coders must have a firm grasp on the similarities and differences between separate 3D rendering and 3D rendering performed in CTAs and MRAs. The most important rule to understand is that no separate 3D reconstruction code should be coded alongside a CTA or MRA code. Rather, 3D is an inclusive component of an angiography scan, and the physician should document the 3D rendering accordingly.

In order to confirm 3D rendering for an angiography scan, you want to look out for one of the same sets of synonymous terms referenced under codes 76376 and 76377. If 3D rendering, postprocessing, or reconstruction is not reported, you want to make sure that the physician uses one of the three terms listed above in their place. If the radiologist does not appropriately document 3D rendering via one of these channels, your options are to either return the report to the provider for clarification or to downgrade the procedure to a CT or MRI scan.