Radiology Coding Alert

CPT replaces troublesome 76375 with 2 new 3D-only codes

Unless your radiologist uses a machine that has 3D capabilities, you'll find it difficult to code for image reconstruction in the new year. Here's why: CPT Codes 2006 includes two new codes that specify the rendering must be 3D, unlike 76375, which said rendering could be 2D, 3D, or holographic.

These are the two new codes that will replace 76375 (Coronal, sagittal, multiplanar, oblique, 3-dimensional and/or holographic reconstruction of computed tomography, magnetic resonance imaging, or other tomographic modality):

• CPT 76376 --3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; not requiring image postprocessing on an independent workstation

• CPT 76377 --...requiring image postprocessing on an independent workstation.

Focus on Image Postprocessing

The new codes differ based on whether the rendering requires image postprocessing on an independent workstation. Translation: If a technician performs the reconstruction on the acquisition workstation, you'll use 76376. But if the physician performs the reconstruction on an independent workstation, you'll use 76377, says Bruce Hammond, COO of Diagnostic Health Services in Addison, Texas.
 
Watch for: Your radiologist needs to change his dictation to clarify who did the reconstruction and where so you can choose the correct code, Hammond says.

Regardless, CPT 2006 imposes a requirement for physician supervision and/or performance of the postprocessing with the instruction that codes 76376 and 76377 "require concurrent physician supervision of image postprocessing 3D manipulation of volumetric data set and image rendering."

Contrast 2005 and 2006 Coding Options

Problem: Many providers were reporting 76375 with too many CT services, and they were starting to code it with ultrasounds incorrectly, says Jackie Miller, RHIA, CPC, senior consultant with Coding Strategies Inc. in Powder Springs, Ga. The new codes limit your reporting options.

Scenario: You perform an axial scan and reconstruct it into the sagittal, coronal, or

2005 method: You report the original scan along with 76375.

2006 method: Only report the original scan. You won't be able to bill 76376-76377 because the reconstruction will only be two-dimensional.

Continue to Be Diligent About Orders

Because 3D reconstruction is a separate code, radiologists should seek an order from the treating physician if they feel it's necessary to perform a reconstruction after a CT scan. Often, radiologists won't know until after they've done the initial CT scan whether they'll need to do a 3D reconstruction to clarify their diagnosis.

Missed opportunity? It would have made more sense for the American Medical Association (AMA) to incorporate 3D reconstruction into the existing CT imaging codes, says Cheryl A. Schad, BA Ed, CPC, ACS-RA, owner and radiology coding and compliance consultant with Schad Medical Management in Mullica Hill, N.J.
 
Why: The HHS Office of Inspector General has gone after radiologists who lacked documentation of a separate order for reconstruction after a CT scan, Schad says. The AMA could have eased the problem by making 3D reconstruction part of CT scans.

Flip side: Having separate codes for 3D reconstruction offers a chance for reimbursement for the significant technological expense and manpower involved.

Experts predict payers may not cover the cost of the lower code but hope that if you perform "high-powered" 3D surgical planning for services such as plastic and bony reconstruction, cancer therapy, or neurosurgical seizure and tumor surgery, you'll be able to make the case that the one- to three-hour reconstructions on workstations deserve payment.

Good idea: Until you know for sure, have patients sign an advance beneficiary notice or equivalent waiver agreeing to pay for this labor-intensive service if insurers don't.