Radiology Coding Alert

Question: Does documenting MIP reconstruction support reporting CTA instead of CT?

Florida Subscriber

Answer: Maximum intensity pixel (MIP) reconstruction does qualify as the "image postprocessing" computed tomographic angiography (CTA) requires because MIP is a 3D technique.

One of the main differences between CT and a typical CTA is that CTA includes angiographic image reconstruction postprocessing and interpretation. The ACR recently clarified its position that to report "angiographic reconstructions" the physician "needs to use different techniques which can all broadly be classified as 3D techniques.

These include maximum intensity pixel (MIP) reconstruction, volume-rendered images, or other 3Dtechniques" (The ACR Radiology Coding Source, May/ June 2009). You should use a standard CT code for 2D postprocessing because 2D planar reconstructions don't count as angiographic reconstruction.

Example: A physician orders a noncoronary chest CTA because he suspects pulmonary embolism. The radiologist's documentation for the service includes 3D rendering.

You should report 71275 (Computed tomographic angiography, chest [noncoronary], with contrast material[s], including noncontrast images, if performed, and image postprocessing).

Tip: The ACR recommends keeping the 3D images in the permanent archive.