Radiology Coding Alert

Question: When we perform a chest CT scan (71260) on a trauma patient, we also reformat the data into a spine exam (72129 or 72132). Can we charge for both chest and spine CTs?

North Carolina Subscriber

Answer: You may report the physician portion for both the chest and spine exams, but not everyone agrees on how the facility should charge.

Professional service: The Spring 2006 issue of the AMA's Clinical Examples in Radiology says that you can report the spine CT code as long as the radiologist offers a complete spine interpretation. For example, if the radiologist performs a complete spine interpretation from reconstructed data, you may append 26 (Professional component) to the appropriate CT code, such as 72129 (Computed tomography, thoracic spine; with contrast material).

Facility charge: You may find conflicting opinions about reporting the technical component, but the American Hospital Association's Third Quarter 2006 Coding Clinic for HCPCS states, "Although the images were reconstructed to show images of the lumbar spine, an additional code for the reconstructed image of the lumbar spine is not required since this did not require a rescanning of the patient."

If the spine exam reformatting involved 3D rendering, then the hospital can charge the applicable 3D code (76376 or 76377). Payers may not be willing to reimburse for the reformatting otherwise because the original scan code includes 2D reformatting.

Pay attention: Watch your payer policies closely because some carriers are just discovering this TC reporting issue and may soon be writing up and implementing guidelines about it.

-- The answers for You Be the Coder and Reader Questions were reviewed by Jackie Miller, RHIA, CPC, senior consultant with Coding Strategies Inc. in Powder Springs, Ga.