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Coding Tip of the Month
Presented by Bracco Diagnostics Inc. Reimbursement Services
May 29, 2001
Issue: CT Angiography
Background
The information in this section was summarized from CPT Changes 2001: An
Insider's View by the American Medical Association.
CT Angiography (CTA) is a new, less invasive technique for imaging vessels.
The information obtained from CTA is used in the evaluation of the following:
- vascular anatomy (e.g. renal transplant donors, congenital abnormalities),
- vascular disorders such as aneurysms, stenoses (e.g. renal , aortic,
carotid),
- cases of suspected vascular trauma (e.g. aortic laceration), and
- follow-up of organ transplantation.
CTA utilizes images obtained with a large volume of rapidly injected
intravenous contrast, acquired with narrower collimation and reconstructed
at shorter intervals than standard CT. These images are optimized specifically
for visualization of the arterial and venous anatomy and any associated
vascular anomalies. Three-dimensional reconstruction can also be performed
and evaluated in multiple projections and cine displays.
Although CTA and conventional angiography may provide comparable information,
CTA offers important advantages over current vascular imaging methods.
Conventional angiography only depicts the vascular lumen. CTA provides
additional information unavailable with conventional angiography including
vessel wall thickness, relationships to adjacent structures, and enhanced
depiction of venous anatomy and target organ parenchyma.
Current Status
With
the continued growth of CT technology, particularly Spiral CT, the use
of CTA has become widespread. Guidelines on Coding for CT Angiography
were first introduced in the July, 1996, ACR Bulletin. At that time, CPT
did not provide specific codes for these procedures, therefore the primary
recommendation was to use the existing CPT codes for the specific anatomic
area being studied in addition to the 3-D CT reconstruction code 76375
(computerized tomography, coronal, sagittal, multiplanar, oblique and/or
3-D reconstruction).
In the 2001 edition of CPT, eight new codes specifically for CTA
are listed as follows:
| 70496 — CTA, head |
73206 — CTA, upper extremity |
| 70498 — CTA, neck |
73706 — CTA, lower extremity |
| 71275 — CTA, chest |
72191 - CTA, pelvis |
| 74175 — CTA, abdomen |
75635 — CTA, abdominal aorta and bilateral illiofemoral
lower extremity runoff. |
With these new codes, the reconstruction/reformatting aspects of the
study are now considered to be included in the anatomy-specific CTA code—therefore
CPT code 76375 is no longer needed.
Contrast Reimbursement Issues
The reimbursement environment for contrast, particularly non-ionic contrast,
has changed for hospital-based patients . With the implementation of the
Hospital Outpatient Prospective Payment System (HOPPS), non-ionic contrast
is no longer reimbursed separately from the procedure, but rather is included
in the Ambulatory Payment Classification (APC) rate. However, hospital
outpatient radiology departments are instructed to continue coding non-ionic
contrast as they did prior to the implementation of APC’s.
The positive news for office-based studies is that non-ionic contrast
continues to be paid separately from the procedures when billed appropriately.
Use the HCPCS codes:
A4645 for concentrations of 200-299mgI/ml
A4646 for concentrations of 300-399mgI/ml.
Approved ICD-9 codes are also still required to document the use of non-ionic contrast in qualified Medicare patients. A common error in coding is the omission of the full five digit ICD-9 code to support the use of non-ionic contrast in qualified patients.
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