Radiology Coding Alert

In virtually all instances, 76375 can be assigned as an additional charge to CT, MRI, PET and SPECT scans if the radiologist has created a reconstructive view and clearly documented it in the medical record, says coding expert Cheryl A. Schad, BA, CPCM, CPC, owner of Schad Medical Management in New Jersey.

Coding professionals throughout the United States have reported confusion over the correct use of 76375 (reconstructive views of computerized tomography [CT], magnetic resonance imaging [MRI], Positron Emission Tomography [PET], and Single Photon Emission Computed Tomography [SPECT] scans).

Some coders are unclear about what comprises a
reconstructive view; others are unsure if 76375 should be submitted by itself, without accompanying imaging codes.

Reconstructive Views Provide Additional Diagnostic Data

Schad explains that a reconstructive view is a computer-generated enhancement created in conjunction with a CT, MRI, PET or SPECT scan. Simply put, a reconstructive view provides another dimension to these basic diagnostic images, she says. Using computer technology, CT, MRI, PET or SPECT images are manipulated to reveal different angles that can possibly expose an abnormality that cant be seen on a plain x-ray film.

According to the American Medical Associations 1999 CPT Manual , supervision and interpretation (S&I) code 76375
includes a variety of reconstructive views:

1. coronal: divides the body, or body section, into front and back planes or portions;

2. sagittal: divides the body, or body section, into left and right planes or portions;

3. multiplanar: revealing several planes;

4. oblique: providing a slanted or diagonal view;

5. three-dimensional: giving the illusion of having depth;

6. holographic images: producing a picture in which the image appears as a three-dimensional representation of the original object.

Common Coding Errors

There are two common errors with reconstructive view coding, says Schad, whose firm specializes in coding services for radiology practices, particularly interventional radiology studies, and helps assure accurate documentation of those services.

The first is submitting the 76375 code without the code for the anatomical site of the CT, MRI, PET or SPECT scan. Reconstructive views can be used in addition to virtually any of these diagnostic studies, she explains. To code a reconstructive view correctly, coders must reference the proper scan (i.e., 74160 for an abdominal CT, or 70470 for the sinus cavity CT). Then, 76375 can be added for the reconstructive view charges.

The second error results from inadequate documentation. The reconstruction software must be used and documented within the written radiology report, Schad stresses. This is key to minimizing denials. The radiologist must clearly state which of the reconstructive views was createdcoronal, sagittal, multiplanar, oblique, three-dimensional or holographic.

In the event of an audit, this clearly illustrates why you used 76375.

Case Study:
Coding MRI of the Abdomen

MRI of the abdomen: Multiple serial sagittal, axial, and coronal images were obtained through the hepatobiliary system. The intrahepatic bowel ducts are slightly ectatic (marked by dilation of a tubal structure), but the left or right bowel ducts are not significantly dilated.

The intrahepatic common bile ducts as well as the extrahepatic common bile duct are somewhat dilated and ectatic, but otherwise unremarkable. This may reflect post-cholecystectomy dilatation. The post-cholecystectomy stump is visualized and is unremarkable. The pancreatic duct is normal in course and caliber. No evidence for obstruction is seen.

Impression: There is biliary ductal ectasia and dilatation primarily of the common bile duct, with minimal lesser changes noted in the intrahepatic ducts.

Coding recommendation: Under these circumstances, Schad says, the coder would assign 74181 for the MRI of the abdomen. Plus, because sagittal and coronal are clearly documented, the coder can add 76375. If the radiologist had neglected to say sagittal or coronal, the coder would not have been able to add 76375.

She points out that the code description for 76375 in the CPT 1999 manual contains the word or in its list of all of the types of enhancements that comprise a reconstructive view. Its important to remember that mentioning just one of them will entitle a practice to add the code.