Radiology Coding Alert

Question: I've been hearing conflicting information about 76375. Some say Medicare is still paying for the additional CT charges, while others say auditors are out to get practices that report this code. What should we do?


Washington, D.C., Subscriber

Answer: Coders have had plenty of questions about reconstruction since the Department of Justice hammered a radiology practice last summer for violations that included claims for 76375 (Coronal, sagittal, multiplanar, oblique, 3-dimensional and/or holographic reconstruction of computed tomography, magnetic resonance imaging, or other tomographic modality). According to the American College of Radiology, reconstruction doesn't require a separate order from the referring physician. Note: The service must be medically necessary and appropriately documented. Always have the radiologist dictate why the reconstruction needed to be performed.

Remember: Your claim may not stand up to auditor scrutiny even if Medicare pays. And if you code reconstruction routinely (with all or most of your exams), you may be setting yourself up for an audit. Plus: You may have an auditor who demands orders for reconstructions, so you may choose to get orders every time to be on the safe side.

The point is to be able to defend your actions when push comes to shove, and many experts believe documented medical necessity and avoiding routine reconstruction should keep you in the clear under the test design parameter clause.

Try this: Clearly state the medical reason for the reconstruction in any plane(s) other than the original images' plane. Useful: Discuss the necessity of these reconstructed images with the referring physician and document that discussion in the report, especially if these additional reconstructions do not appear in the referring physician orders.

Important: Pay attention to the descriptor to see how the American Medical Association intends you to use 76375. You can report 76375 in addition to routine CT, MRI, or other tomographic modality procedures when the radiologist uses coronal, sagittal, multiplanar, oblique, 3-D and/or holographic reconstruction techniques.

Pitfall: Many coders mistakenly report 76375 for CT/MRI imaging procedures radiologists perform in the coronal, sagittal, multiplanar and/or oblique planes. In reality, you should only use this code to report studies that have been reformatted from one plane into another.

Helpful: Don't report the separate code 76375 unless you see evidence of a separate procedure for reconstruction. CT and MR angiography include reconstruction, so don't use 76375 with these procedures.