InsightsRadiology

Chest CT – Correct Coding and Billing

With the constant stream of news updates coming out lately it’s a challenge to keep up – many of us feel our heads is spinning from all the information! One topic that continues to pop up is chest CT.

Information about the use of chest CT during the current public health emergency continues to vary. The American College of Radiology (ACR) does not recommend the use of CT for initial screening or as testing to diagnose COVID-19 due to the fact that “a normal chest CT does not mean a person does not have COVID-19 infection – and an abnormal CT is not specific for COVID-19 diagnosis.”

That’s not to say that CT doesn’t have a place in the treatment of patients with COVID-19. The ACR recommends that CT be reserved for use in patients “with specific clinical indications for CT” and researchers in Italy have found value in the use of CT to aid in predicting outcomes for patients with COVID-19 pneumonia.

No matter how this situation continues to evolve, it is still important to ensure any CT services provided continue to be coded and billed appropriately.

Chest CT – A Quick Review

71250    CT, thorax; without contrast material

71260    CT, thorax; with contrast material(s)

71270    CT, thorax; without contrast material, followed by contrast material(s) and further sections

Whether described as chest CT, CT of the chest, or CT of the thorax, all are defined by codes 71250-71270. These scans may be ordered to evaluate abnormal or suspected abnormal areas of the lungs, pleura, chest wall, mediastinum, or to detect a pulmonary embolism. Dynamic studies are not charged any differently than typical procedures.

The most common mistake we see with the use of these codes, as with many CT codes, is unbundling. Unbundling refers to charging multiple CPT codes when a single, more extensive option exists. Per the NCCI Policy Manual for Medicare Services, Chapter IX, Section A: “A physician shall not report multiple HCPCS/CPT codes if a single HCPCS code exists that describes the services. This type of unbundling is incorrect coding.”

In the case of CT scans, the site-specific codes for without, with, and without followed by with contrast should not be reported together when performed at the same encounter. This would fall into the territory of unbundling. As an example, for the above chest CT codes this would be reporting 71250 and 71260 instead of 71270, or 71260 and 71270 together.

Best Practice Documentation

To ensure the proper code(s) are assigned for CT scans, each report needs to tell what was imaged and, more importantly, how it was imaged. There are five key elements that should be included in each report:

1. What is the study? (i.e., CT, CTA)

2. What anatomic area was studied?

3. How was it imaged? Without contrast, with contrast or without and with contrast?

4. What type of contrast was used?

5. How much contrast was administered and, preferably, how much was discarded?

Case Example

CT CHEST W/ CONTRAST

Clinical Indication: Abnormal pulmonary scan.

Technique: Volumetric low dose helical CT imaging of the chest was performed on the GE 64 slice VCT with ASIR dose reduction. 50 cc of Isovue 370 non-ionic contrast was injected without adverse reaction.

Findings:

Lungs and Pleura: There is a moderate centrilobular and paraseptal emphysema. There is biapical scarring. Brochiectasis with areas of mucoid impaction is similar to the prior. There are nodule opacities scattered throughout both lungs, many of which are stable and probably reflect areas of mucoid impaction. A few opacities appear increased bilaterally. There is no pleural effusion or pneumothorax.

Mediastinum: Overall heart size is within normal limits though the right atrium and right ventricle are mildly prominent. There is moderate atherosclerosis of the thoracic aorta. Central pulmonary arteries are mildly prominent, with the left pulmonary artery measuring the same caliber as the descending aorta suggesting pulmonary hypertension. There is no suspicious adenopathy in the chest.

Bone and Soft Tissues: No acute bony abnormality. Mild degenerative disc disease in the thoracic spine.

Impression: Emphysema with bronchiectasis and mucoid impact. Bilateral pulmonary nodules, a few of which appear increased. No dominant lesion is seen and continued follow up is recommended.

CPT Code: 71260

Avoid Common CT/MR Coding Mistakes

Commonly performed, commonly coded yet numerous problem areas exist with coding and billing for CT/MR services. What’s separately billable for combination studies (i.e., CT/CTA, MRI/MRA) performed at the same encounter? What must be documented in order to code for a CTA? Are your charges fully supported in the documentation? Through scenarios illustrating problem areas and best practices, this webcast presented by Jeff Majchrzak will make sure you avoid common mistakes. LEARN MORE!