Radiology Coding Alert

In the Q&A, the ACR states that "Three-dimensional angiography is a tomographic modality wherein an x-ray tube rotates about an isocenter collecting data at various reference points. The data is typically sent to an independent workstation for postprocessing. Since this is typically performed on an independent work station, 76377 (... requiring image postprocessing on an independent workstation) is the appropriate code to report for this procedure" (www.acr.org/Hidden/Economics/FeaturedCategories/Pubs/coding_source/archives/NovemberDecember2006/Coding_qa.aspx#q2).

Case in point: In Philips' premarket notification to the FDA, it states the "Integris 3D-RA release 4.2 device allows the user to obtain a three dimensional impression of vasculature with a single contrast injection. This 3D impression is acquired by rotating the C-arm isocentrically around the region of interest. Exposures are made as the arteries in the region of interest are being filled. The set of 2-Dimensional images form the rotational angiographic examination and is transferred via DICOM connection to the 3D-RA workstation. A 3-Dimensional image is constructed from the delivered image information resulting in an object which can be viewed from almost any angle" (www.fda.gov/cdrh/pdf4/k040254.pdf).

Watch out for this: As the paragraph above indicates, the 3D reconstruction is not the same as 2D rotational angiography.

As additional support for this notion, another question in the same Coding Source "Coding Q&A" states that if the radiologist performs rotational angiography during an abdominal aortogram, for example, you would report only the abdominal aortogram code. Reason: All necessary views are included in the aortography code.