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Coding and compliance tips and traps

October 01, 2021
Business Affairs X-Ray
From the October 2021 issue of HealthCare Business News magazine

Primary concerns in CT relate to the billing of CT and CTA during the same encounter, and appropriately assigning 3D codes. In most cases it is not appropriate to report a CT code together with a CTA code for the same body area. In order for both exams to be billed, the CTA must involve a “new data acquisition” and there must be an order from the treating physician for both exams, both exams must be medically necessary, and both must be separately and completely documented.

The code assignment for 3D rendering depends upon whether the 3D postprocessing was performed on the scanner workstation (76376) or an independent workstation (76377). Code 76377 should not be assigned unless the radiology report indicates an independent workstation was used for the postprocessing. The 3D rendering codes require concurrent physician supervision of image postprocessing, 3D manipulation of the volumetric data set, and image rendering. If the 3D rendering is performed on a different date of service than the CT or MR scan it is still appropriate to submit 76376 or 76377 for the rendering of the 3D images.

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There are few MRI coding concerns, and breast and prostate top the list for many organizations. The assignment of correct procedure codes is dependent on the location and payer. Medicare still maintains the C codes for the technical component (TC). Non-hospital TC contrast-only examinations should be reported with the unlisted code 76498 since there is currently no procedure code for this service. For patients with dense breast tissue in which an abbreviated breast MRI (AB-MRI) is performed for cancer screening, it is appropriate to bill either code 77048 or 77049. These codes were intended to be used for screening and diagnostic breast MRI.

Some imaging facilities use computer-assisted detection (CAD) software such as DynaCAD to evaluate prostate MR studies. There is no code for prostate MRI CAD. This service can be reported using the unlisted MRI procedure code, 76498 and the appropriate MRI pelvis code.

Melody W. Mulaik
This article highlights just a few of the issues that should continually be evaluated to protect your organization’s compliance and reimbursement. Correct coding and compliance are a journey, not a destination. While it may not make the short list of favorite things to address, it is important and can yield great rewards — figuratively and literally.

About the author: Melody W. Mulaik, MSHS, CRA, RCC, RCC-IR, CPC, COC, FAHRA, is the president of Revenue Cycle Coding Strategies

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