Wiki CT brain without then with contrast - HELP

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Dfreddie

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I need some help to clarify this situation. Radiology is telling me that they are billing both 70450 and 70460 because they were performed a little over an hour apart. Reason for the first scan was left-sided facial weakness, reason for the next w/contrast was possible dural mass.

In my research, this would not be appropriate and no modifier is applicable - the correct code on the same DOS would be 70470.

Am I right? Or am I missing something?
 
You are correct! Per the NCCI edits billing both is not appropriate and these will be denied. These should be bundled together into code 70470.

4297
 
So what happened... someone looked at the imaging without contrast and said, hey, I think we need some clarity here, do it again with contrast? Or did something else happen?
 
When a CT scan without contrast is reported on the same day as a CT scan with contrast, on the same anatomical site, use the code for "without contrast followed by with contrast". You are right, 70470 would be correct.
 
Would we bill for 70470 even if CT w (70460) is done in the morning and CT WO (70450) is done late in the day?
 
radmedcode said:
I need some help to clarify this situation. Radiology is telling me that they are billing both 70450 and 70460 because they were performed a little over an hour apart. Reason for the first scan was left-sided facial weakness, reason for the next w/contrast was possible dural mass.


Hi - I am a CT tech and a coder. Let me explain this:

In this case, you CANNOT default to 70470.


  • 70470 is only used when the exam is ordered and performed as a single study protocol: CT head without contrast immediately followed by with contrast, same accession, same indication, same encounter.
  • What happened here is different:
    • First scan (70450, without contrast): ordered for left-sided weakness.
    • Second scan (70460, with contrast): ordered later because of a new finding/concern (possible dural mass), which can only be diagnosed with contrast.
    • They were performed at different times, under different clinical indications, and will have separate accession numbers.
    • - this link explains accession numbers.

Because of that, it is not a “without → with” combo study. It is two separate encounters on the same date of service.




Local Coverage Determination (LCD) for CT of the Head​


The relevant LCD for CT head and neck imaging is L37373, titled “MRI and CT Scans of the Head and Neck”, which includes CPT codes 70450, 70460, and 70470 among others (Providers Care Billing LLC, Centers for Medicare & Medicaid Services).



NCCI Edit Relationship​


  • Column 1 Code: 70460 (with contrast)
  • Column 2 Code: 70450 (without contrast)
  • Modifier Indicator: 1 → meaning you can bypass the edit with an NCCI-associated modifier if criteria are met.


What this means:​


  • If both are reported on the same day of service, 70460 is the payable Column 1 code.
  • 70450 is the Column 2 code, which would normally be denied unless you append an appropriate modifier (like XE for a truly separate encounter).
  • The modifier attaches to the Column 2 code (70450) — not the Column 1.


How to apply here:​


  • If the two exams were truly separate encounters (different accessions, different clinical indications, not part of the same continuous study), then:
    • Bill 70460 normally.
    • Bill 70450 with modifier XE to show it was distinct.
Click to expand...


You linked a superceded CMS policy. That's the risk of using ChatGPT as a reference, I suppose:

1756820791789.png


At the very least, if you're going to use chatGPT to look things up, be sure you verify for yourself! If you had clicked on your own reference, you would have noticed that it was superseded, then you could have scrolled to the bottom and gotten the current link, which went into effect on 1/1/2020. Note that the link chatGPT gave you was actually two versions ago:


1756821013750.png


Additionally, the CMS link you gave didn't even reference NCCI edits anyhow. (Nor did the Providers Care Billing, LLC link that chatGPT also gave you. A billing company link wouldn't be an official source anyhow, though they can be useful for giving you direction to find the primary source for the information.)



Lastly, it is not a Modifier Indicator 1 on the NCCI edits - it's a Modifier Indicator 0. (Which means "no modifier allowed" to override the edit.)

This is from the current NCCI PTP edits. (Note that someone else above had posted a screenshot of the NCCI PTP edits from 2020 too - since the edit has been in effect since 1/1/1996, it hasn't changed since that poster shared her screenshot.)

1756820580302.png
 
Last edited:
I want to point this out not to be unkind, but to highlight why it’s so important to carefully review and validate anything you get from ChatGPT when it comes to coding information.

ChatGPT can be a really useful tool for brainstorming, drafting, or general guidance - but it should never be treated as a primary coding reference. It frequently gives incorrect answers or outdated/irrelevant source links.

For example, I once tried asking it to help me find journal articles I could read for a paper I was writing, and it made up articles about the subject that simply didn’t exist. That kind of issue really underscores the need to double-check any information you use from it.
 
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