Radiology Coding Alert

Question: Can I submit a computed tomography (CT) head without contrast along with a same-day CT angiography (CTA) CTA head?

Utah Subscriber

Answer: Depending on the patient’s condition, these two procedures can be ordered together to help the physician make a proper diagnosis and subsequent treatment plan. In these instances, the provider is typically performing the CTA in order to visualize the cerebral vessels. On the other hand, the CT scan will be primarily focused on evaluating the skull, brain tissue, and corresponding structures. In most cases, you’ll find a different diagnosis on the CTA from its CT counterpart. One instance in which you may end up reporting the same diagnoses for each is if the indicating diagnoses are the same and the impressions yield a normal scan.

No matter the diagnostic results, you may separately bill for these scans since they are imaging separate anatomic overlapping sites. In performing a National Correct Coding Initiative (NCCI, or CCI) edits check, you’ll find that 70450 (Computed tomography, head or brain; without contrast material) bundles into 70496 (Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing) as the column 2 code. You may either append code 70450 with modifier 59 (Distinct Procedural Service) or modifier XU (Unusual non-overlapping service) for Medicare Part B patients.