Radiology Coding Alert

76375 rules limit your choices

If your practice’s watercooler buzz has been about the proper use of 3-D reconstruction code 76375, you’re not alone. The most recent National Correct Coding Initiative edits offer clarification telling you not to code 3-D reconstruction with a number of nuclear medicine codes.

Build Solid Reconstruction Claims

The new edits bundle 76375 (Coronal, sagittal, multiplanar, oblique, 3-dimensional and/or holographic reconstruction of computed tomography, magnetic resonance imaging, or other tomographic modality) into PET/CT codes CPT 78814 -CPT 78816 because of coding guidelines, says Cindy Parman, RCC, CPC, CPC-H, co-owner of Coding Strategies Inc. in Powder Springs, Ga.

Remember that 76375 is for multiplanar reconstruction. CPT Changes 2005 defines 78814 (Tumor imaging, positron emission tomography [PET] with concurrently acquired computed tomography [CT] for attenuation correction and anatomical localization; limited area), explaining that the service includes “acquisition and reconstruction of the PET data in multiple planes,” Parman says. You should not code reconstruction (76375) separately because reconstruction appears to be included in 78814 and the other PET/CT codes.

Boost Coding Skills by Understanding Technology

Code 76375 is now bundled into most other nuclear medicine codes, as well. The only diagnostic nuclear medicine exam omitted from the edits is bone density (78351, Bone density [bone mineral content] study, one or more sites; dual photon absorptiometry, one or more sites), which typically isn’t a covered service.

Learning about imaging processes will help you understand the rationale for these edits, says Bruce Hammond, CRA, CNMT, COO of Diagnostic Health Services in Texas.

Example: NCCI version 11.3 bundles 76375 into 78320 (Bone and/or joint imaging; tomographic [SPECT]). The gamma camera used for SPECT acquires 3-D images. Coding 76375 because the SPECT documentation revealed 3-D images would be a misuse of 76375. Why: You should only use 76375 to report studies that the provider reformats--not studies that inherently involve 3-D imaging.

Forget 59 as a Fix-All

These edits have a modifier indicator of “1,” meaning that you may report the two codes together when appropriate. Caution: Appending modifier 59 (Distinct procedural service) to your claims may automatically break bundles with your payer, but that doesn’t mean you made a correct coding choice.

Why: Medicare instructs you to use modifier 59 when the services “occur at a different anatomic site or a separate patient encounter,” Parman says. Only append 59 to your code if you meet these requirements--an unlikely occurrence for these particular bundles.