Radiology Coding Alert

Question: Can I report 71270 if the radiologist performs preliminary images without contrast and then more images with contrast? Is there any designated number of views the "without contrast" part of a CT or MRI study needs to be in a hospital?

Connecticut Subscriber

Answer: Payer policies will likely not give you a minimum number of without contrast slices or views to qualify for a "without and with contrast" code, such as 71270 (Computed tomography, thorax; without contrast material, followed by contrast material[s] and further sections).

A more important question may be, what did the treating physician order? If the ordering physician considers without and with contrast imaging to be medically necessary and the radiology team provides images without and with contrast, you should report the corresponding "without and with" code.

Orders: The rules for ordering diagnostic tests in a hospital setting say you can provide radiology services only on the orders of practitioners with clinical privileges (or other practitioners authorized by the medical staff and governing body, as long as you're consistent with state law). You'll find this guideline at 42 CFR 482.26.

Snag: Even if your radiologist has clinical privileges, fiscal intermediaries often deny claims unless you have an order from the treating physician.

If an interventional radiologist orders follow-up imaging studies, you may be able to successfully appeal the denial if the medical record supports the treating status of the interventional radiologist.