Radiology Coding Alert

Question: How should I code a report for injection of contrast material through a surgically placed T-tube to view bile ducts along with separate radiological supervision and interpretation (RS&I) during a
pancreatography?


Michigan Subscriber


Answer: If the radiologist performs the T-tube study after (not during) the surgery, which is most often the case for radiology services, report 74305 (Cholangiography and/or pancreatography; through existing catheter, radiological supervision and interpretation) for the RS&I and CPT 47505 (Injection procedure for cholangiography through an existing catheter [e.g., percutaneous transhepatic or T-tube]) for the injection, because the radiologist performs the contrast injection through a previously placed catheter.

If the surgeon performs the intraoperative contrast injection and you are coding only for the imaging service, you would report CPT 74300 (... intraoperative, radiological supervision and interpretation).

If you are coding for the radiologist's professional service, and the radiologist is not present during the intraoperative contrast exam, add modifier 52 (Reduced services) to show that you are billing for interpretation only. If the surgeon supervised the imaging but did not interpret the films, the surgeon's claim should also include modifier 52.

You may report +74301 (... additional set intraoperative, radiological supervision and interpretation [list separately in addition to code for primary procedure]) as an add-on to 74300, representing the separate RS&I for subsequent sets of images obtained during the surgery. There are no injection codes for these intra-operative images because the injection of contrast by the surgeon is bundled into the surgery.