Radiology Coding Alert

Remember that contrast injection is included with CTAs.

You may have computed tomography (CT) coding down pat, but using CT for angiography makes it a whole new ballgame. These scenarios and essential tips will keep your CTA coding on track and accurate reimbursement rolling in.

Understand how to correctly code CTA abdomen studies with this rundown.

Learn How CTA Differs From Traditional CT Scans

Computed tomography (CT) scans create cross-sectional images of the patient’s body using X-rays and a computer. Providers use this procedure to visualize the soft tissues, organs, and skeletal structures of the body. For example, a radiologist may perform 74150-74170 (Computed tomography, abdomen …) “to image the appendix if it is believed the patient may have appendicitis,” says Taylor Berrena, COC, CEMC, CFPC, quality assurance analyst, Tidewater Physicians Multispecialty Group, Newport News, Virginia.

The focus of a CTA is to image the arteries, veins, and blood vessels within the body. Providers will order CTA tests to diagnose, manage, and treat several cardiovascular diseases, including blood clots, aneurysms, blockages, dissections, and stenosis. “A CTA abdomen may be ordered to image the abdominal aorta if it is suspected that the patient may have an abdominal aortic aneurysm,” Berrena adds.

During CT and CTA procedures, the provider injects contrast material through an intravenous (IV) line to help the blood vessels and tissues stand out during the scan. By injecting contrast material, the provider can visualize the body structures better during the study.

Choose the Correct CTA Abdomen Code

The CPT^® code set includes various codes related to CTA, each of which is dependent on the body area the provider examines. The focus here is on the codes that apply to the abdomen and pelvis. Examine the following scenarios to see if you can choose the correct CTA code for each one.

Scenario 1: A patient presents to a radiology facility for a CTA of their abdomen and pelvis. The patient’s primary care physician (PCP) referred the patient for the CTA to evaluate the patient’s acute abdominal pain. The patient’s PCP wants the patient’s blood vessels examined to check for narrowing or blockages, since the patient underwent a CT scan of the abdomen and pelvis, coded to 74177 (Computed tomography, abdomen and pelvis; with contrast material(s)), the week before with the results showing no issues with the patient’s organs.

In this scenario, you’ll assign 74174 (Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing) since the patient “presented for both a CTA of the abdomen and a CTA of the pelvis on the same date of service,” Berrena says.

Scenario 2: A patient is referred to a radiology facility for a CTA of their abdomen to evaluate the blood vessels and check for abnormal ballooning of an artery. After reviewing the radiologist’s report, the patient’s PCP orders a CTA of the pelvis four days later for a similar evaluation.

Since the provider performs the CTA on only the abdomen on the first date of service, you’ll assign 74175 (Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and image postprocessing). You’ll assign 72191 (Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing) on a separate claim to report the CTA of the pelvis performed during a later encounter.

Remember These Helpful CTA Hints

Coding CTA procedures is more than just assigning the correct code. There are several tips to ensure proper reimbursement for the provider’s services.

1. Image postprocessing is included: Image postprocessing involves enhancing the captured images to help providers make an accurate diagnosis. When you review the descriptors for 74174 and 74175, you’ll find the term “image postprocessing.” This means you shouldn’t report a separate image postprocessing code, such as 76376 (3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; not requiring image postprocessing on an independent workstation) or 76377 (… requiring image postprocessing on an independent workstation).
2. Aorto-iliofemoral runoff study: When the provider performs 75635 (Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast material(s), including noncontrast images, if performed, and image postprocessing), you shouldn’t report a CTA abdomen code as well. The CPT^® code set features a parenthetical note to not report 75635 in conjunction with 74174 or 74175.
3. Contrast is included: Contrast material injection is an included component of CTA procedures. The entity providing the contrast material will be able to report that separately, so you shouldn’t report a separate HCPCS Level II code for the contrast material supply.