Radiology Coding Alert

Question: We perform CTs of the thorax to rule out pulmonary emboli. At the same time, we evaluate and report the findings of the mediastinum, lungs, ribs and other structures - not just the condition of the aorta and pulmonary vessels. We also frequently do multiplanar reconstruction in several views to look for emboli. Should we charge for both a CT and CTA? What about reconstruction?


Alabama Subscriber


Answer: For the example you provide, report a CTA of the thorax (71275, Computed tomographic angiography, chest, without contrast material[s], followed by contrast material[s] and further sections, including image post-processing).

Don't report a CT (CPT 71250 -CPT 71270 ) or reconstruction (76375, Coronal, sagittal, multiplanar, oblique, 3-dimensional and/or holographic reconstruction of computed tomography, magnetic resonance imaging, or other tomographic modality).

The American College of Radiology states that the difference between CTA and CT is that CTA includes reconstruction post-processing of angiographic images and interpretation. Translation: No post-processing, no CTA. (ACR Bulletin, July 2001.)

Because you perform reconstructions to evaluate the pulmonary vasculature for emboli, you should code a CTA of the chest instead of just a CT.

Caution: Don't charge both a CT and CTA for your example. The ACR suggests coding a CT and CTA of the same region very rarely - typically when the CT reveals abnormal findings and the physician decides to perform a CTA for more information.