Radiology Coding Alert

See how this authoritative guidance might affect your mammogram, PET/CT coding, and more.

Continuing education as a coder entails much more than maintaining your respective certification. It also extends beyond staying up to date on what’s new within the annual coding book updates.

In order to be the best version of your coding self, you’ve also got to stay on top of all the new and revised sets of authoritative guidelines that impact your specialty. Today, you’re going to get a refresher on a few key diagnostic and interventional radiology coding advice updates from CPT^® Assistant. “CPT^® Assistant is an invaluable resource that offers insights into procedural coding through clinical scenarios, Q&As, and a lot more,” says Lindsay Della Vella, COC, medical coding auditor at Precision Healthcare Management in Media, Pennsylvania.

Read further to recalibrate your coding skills using the following sets of coding guidance.

Look for Tomosynthesis Documentation Anywhere in Report

The first order of business offers up some clarification on mammographic services involving tomosynthesis. In response to a reader question (RQ), CPT^® Assistant (Volume 30; issue 9) states the following:

“As long as the report makes it clear that both planar two-dimensional (2D) mammograms and tomosynthesis were performed in acquiring images for interpretation, it is appropriate to report codes for both the planar mammogram and for tomosynthesis.”

CPT^® Assistant elaborates on a question surrounding documentation criteria for tomosynthesis services by explaining that the documentation for tomosynthesis does not need to fall within any particular section of the radiologist’s interpretation report. Whether it’s in the technique, findings, or otherwise, you may report codes 77061 (Diagnostic digital breast tomosynthesis; unilateral), 77062 (… bilateral), or +77063 (Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary (…procedure)) in addition to the appropriate mammogram code.

Consider Modifier 59 Usage for Diagnostic CT Alongside PET/CT

Next up, you’ll want to take note of some revised 2020 Nuclear Medicine guidelines that CPT^® Assistant (Volume 30 Issue 7) further expounds upon. First, have a look at the guidelines in discussion:

• “Myocardial perfusion (SPECT and PET) and cardiac blood pool imaging studies may be performed at rest and/or during stress. When performed during exercise and/or pharmacologic stress, the appropriate stress testing code from the 93015-93018 series may be reported in addition to 78430, 78431, 78432, 78433, 78451-78454, 78472, 78491, 78492. PET can be performed on either a dedicated PET machine (which uses a PET source for attenuation correction) or a combination PET/CT camera (78429, 78430, 78431, 78433). A cardiac PET study performed on a PET/CT camera includes examination of the CT transmission images for review of anatomy in the field of view.”

CPT^® Assistant goes on by explaining that you should append modifier 59 (Distinct procedural service) when a diagnostic CT scan is reported in addition to a combination PET/CT. Furthermore, the respective dictation reports need to “support the medical necessity of the separate diagnostic CT scan.”

In order for medical necessity to support a separate diagnostic CT scan, you need documentation supporting one of the following: an entirely distinct condition that justifies separate imaging, or written justification that argues that a separate diagnostic CT is needed in tandem with the PET/CT in order to gain a clear diagnostic picture for subsequent treatment.

Gain Additional Insights Into Modifier 22 Reporting

Your last point of order comes by way of CPT^® Assistant (Volume 30; Issue 5). This issue includes some helpful guidance on modifier 22 (Increased procedural services) reporting as it pertains to the amount of time a procedure takes. Within Appendix A of the CPT^® code book, CPT^® outlines a few of the following variables to consider when making a modifier 22 determination:

• Increased intensity;
• Time;
• Technical difficulty of procedure;
• Severity of patient’s condition; and
• Physical and mental effort required.

CPT^® Assistant argues that time, while not the sole indicator of modifier 22 usage, “can be used as a measure” of physician work. However, CPT^® Assistant goes on to explain that documentation from the physician or other qualified healthcare professional “should reflect all elements of the increased work” to support use of modifier 22.

While some degree of this guidance is open to interpretation, the general idea is that you should include all elements of the report in your justification for modifier 22 — even if the time variable alone meets the criteria.