Radiology Coding Alert

Question: A patient had a limited CT of the orbits at our hospital before his MRI because the physician suspected the patient had metal in his eye. Should I report 70480-52 for this service?

Georgia Subscriber

Answer: You are correct that you may report 70480-52 (Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material; reduced services) for this service.

Payers may also accept 76380 (Computed tomography, limited or localized follow-up study) because it specifically describes a limited CT exam.

Snag: Physicians typically use x-ray rather than CT for pre-MRI foreign-body screening, so your payer may not want to pay for the more expensive CT service. Be sure the doctor documents his reason for choosing a CT rather than an x-ray.

You'd also be wise to get an order from the treating physician for the orbit exam. Why: CMS says that Medicare's diagnostic test ordering rules apply only in the office setting, but fiscal intermediaries often demand that hospitals produce orders for every outpatient exam you do.

Don't miss: If the patient is covered by a managed care plan or commercial insurance, you'll almost certainly have to precertify the CT scan.

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