When it comes to billing for CT reformatting, such as reformatting a CT of the lungs to evaluate the thoracic spine, the key considerations revolve around whether the reformatting constitutes a separately billable service and how it aligns with coding and reimbursement guidelines. Based on standard radiology billing practices and guidance from organizations like the American College of Radiology (ACR), here’s how this situation can be approached:
In your example, a patient undergoes a CT of the lungs (likely a CT chest, e.g., CPT code 71260 if with contrast, or 71250 if without contrast), and later the provider orders an evaluation of the thoracic spine. The technologists then reformat the existing CT chest data to produce images optimized for the thoracic spine. The question is whether this reformatting allows you to bill for a separate CT thoracic spine study (e.g., CPT code 72129 for with contrast or 72128 for without contrast).
Billing Considerations
Technical Component Only for Initial Scan:
The technical component (TC) of the initial CT chest covers the acquisition of the raw data. Reformatting images from this existing data set is generally considered part of the initial procedure’s technical work, as no new imaging acquisition occurs. Therefore, you typically cannot bill an additional technical component for the reformatted thoracic spine images.
Professional Component for Interpretation:
The professional component (modifier -26) reflects the radiologist’s interpretation of the images. If the radiologist interprets the reformatted thoracic spine images as a distinct study—separate from the chest interpretation—and documents it accordingly, you may be able to bill for the professional component of the thoracic spine CT (e.g., 72129-26 or 72128-26). This is supported by ACR guidance, which indicates that when reformatted images are ordered and interpreted as a separate study (e.g., for a new clinical indication like spine trauma), the professional component can be reported separately.
No New Acquisition, No Separate Full Study:
Since the reformatting uses the original CT chest data without a new scan, you cannot bill a full, independent CT thoracic spine study (i.e., both TC and professional component) as if it were a standalone procedure. Payers, including Medicare, typically bundle the technical aspect of reformatting into the initial imaging study unless a separate acquisition is performed.
Practical Billing Approach
Bill the Initial CT Chest: Use the appropriate CPT code for the CT chest (e.g., 71260 for with contrast) to cover both the technical and professional components of the lung study.
Bill the Professional Component for Thoracic Spine (if applicable): If the provider’s order for the thoracic spine evaluation is distinct, and the radiologist provides a separate interpretation and report for the thoracic spine, append modifier -26 to the thoracic spine CPT code (e.g., 72129-26). Ensure documentation clearly supports the separate clinical indication and interpretation.
Avoid Double Billing the Technical Component: Do not bill the technical component (TC) for the thoracic spine, as the reformatting does not involve new image acquisition.
Example Scenario
CT Chest Performed: Billed as 71260 (CT chest with contrast, assuming contrast was used).
Thoracic Spine Reformatted: Radiologist interprets the reformatted images for a spine-specific indication (e.g., suspected fracture) and documents a separate report. Bill 72129-26 (professional component only for CT thoracic spine with contrast).
Documentation Requirements
To justify billing the professional component for the thoracic spine:
The provider’s order for the thoracic spine evaluation should be documented.
The radiologist’s report should clearly delineate the interpretation of the thoracic spine as distinct from the chest findings.
The clinical indication (e.g., trauma, pain, or suspected pathology) for the spine evaluation should be evident.
Caveats
Payer Policies: Some payers may have specific rules about billing reformatted studies. Check with your local Medicare Administrative Contractor (MAC) or commercial payers for clarification.
Bundling Risk: If the spine reformatting is deemed incidental to the chest CT (e.g., routine protocol without a separate order), payers may deny separate billing even for the professional component.
Contrast Use: Ensure the contrast status aligns between the chest and spine codes (e.g., both with contrast or both without).
Conclusion
You can bill for the reformatting of the thoracic spine in this scenario only for the professional component (e.g., 72129-26), provided there’s a separate order and interpretation. The technical component is not billable since no new scan was performed.