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Find out which CT scans require 3D rendering.

Whether you’re newly credentialed or have been coding for years, you’re bound to have questions about computed tomography (CT) coding. Luckily, we’ve rounded up some of the most frequently asked questions (FAQs) to deliver the answers you seek.

Read on to learn the truth behind three CT scan coding FAQs.

What is the difference between a CT scan ‘with contrast’ and ‘without contrast’?

The difference between imaging studies “with contrast” and “without contrast” is more than just three letters. You must also consider the type of contrast administration, the body area examined, and the procedure performed to correctly code CT scans with or without contrast.

The CPT^® guidelines preceding the Radiology section of the code set state that you may only report “with contrast” imaging scans when the contrast material is administered:

• Intrathecally (into the fluid-filled spaces of the spinal cord)
• Intra-articularly (into the joint space)
• Intravascularly (into the blood vessels)

The guidelines also indicate that if the provider administers only oral or rectal contrast, then you cannot report a “with contrast” imaging code.

How do we bill CT scans of multiple body areas in a single session?

Correctly billing CT scans of multiple body areas during a single session requires careful examination of the code descriptors and guidelines. You’ll need only one CPT^® code to report imaging for some body areas, while other body areas require multiple codes.

Take a look at the following examples to examine this information in action:

Scenario 1: A patient presents to a radiology clinic with complaints of lower abdominal pain lasting for more than three weeks. Their primary care physician (PCP) referred the patient for CT scans of their abdomen and pelvis. The radiologist captures CT scans of the abdomen and the pelvis with contrast, interprets the images, and writes their report.

You’ll assign 74177 (Computed tomography, abdomen and pelvis; with contrast material(s)) to report the services in this scenario. If the provider performed separate CT scans with contrast of the abdomen and pelvis on separate dates of service, then you’d assign the individual codes — 74160 (Computed tomography, abdomen; with contrast material(s)) and 72193 (Computed tomography, pelvis; with contrast material(s)) — to report the imaging procedures. However, since the radiologist captured images of both body areas during the same session, the CPT^® code set instructs you to use a single procedure code.

Scenario 2: A patient is admitted to the emergency department (ED) following a car accident. The patient experienced traumatic injuries to the head and face. The radiologist captures CT scans with contrast of the patient’s head and face to assess the extent of the injuries. Following the procedures, the radiologist interprets the images and writes their report.

In this scenario, even though the face is part of the head, you’ll need to report two separate codes to bill for the CT scans. You’ll assign 70460 (Computed tomography, head or brain; with contrast material(s)) to report the CT scan of the head with contrast and you’ll assign 70487 (Computed tomography, maxillofacial area; with contrast material(s)) to report the facial CT scans with contrast.

What are the coding rules for CT scans performed with 3D rendering?

Radiologists and other healthcare providers might need to create a more lifelike view of anatomical structures to assess the patient’s condition or to prepare for surgeries. In that case, the providers can render 3D images following the imaging scans.

“3D reformatted images are what differentiates a CT from a CT angiography [CTA]. The radiologist must document everything they would for a CT and that the study was performed with 3D postprocessing images to support a CTA,” says Kristen R. Taylor, CPC, CHC, CHIAP, associate partner at Pinnacle Enterprise Risk Consulting Services.

3D rendering services are reported using either of the following codes:

• 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 (… requiring image postprocessing on an independent workstation)

You’ll assign 76376 when the provider performs the image postprocessing on the same workstation. On the other hand, if the postprocessing is performed on another workstation, then you’ll assign 76377 for the service.

According to notes listed under 76376 and 76377, the codes are to be reported “in conjunction with code[s] for base imaging procedure[s].” This means that you’ll report the CT scan procedure code along with 76376 or 76377 when the provider performs a CT examination and 3D rendering.

Additionally, the CPT^® code set lists several procedure codes that cannot be reported alongside the 3D rendering codes. Examples of CT-related procedure codes that cannot be reported along with 76376 or 76377 include, but are not limited to:

• 70496 (Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing)
• 70498 (Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and image postprocessing)
• 73206 (Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing)
• 74261-74263 (Computed tomographic (CT) colonography, diagnostic, including image postprocessing …)

Mike Shaughnessy, BA, CPC, Development Editor, AAPC