cindyseyer
Guest
My radiologist is asking if they can charge 72175, 75574 and 74174 when they perform CTA's in workup prior to TAVR. As far as my research seems to indicate, these three are billable when performed in the same session. As far as the aortic annular and vascular measurements, I believe they are performed by Medtronic. Does that sound right to you? My rad didn't perform that portion and wants to make sure we aren't billing for something he didn't do.
I understand the ECG gating is bundled into the 75574, right? Would you bill all three CTA codes? If not, can you guide me to any literature saying so?
Thank you!
Here is an example:
EXAM: CT TAVR W/CONTRAST-TG #/##/2018
*
HISTORY: ##-year-old male with aortic stenosis undergoing preprocedural
evaluation and planning for TAVR.
*
TECHNIQUE: After scout images, a noncontrast gated scan of the heart and
nongated acquisition of the chest abdomen pelvis was acquired. Using
retrospective dose modulated ECG gating, CT angiography of the heart, was
obtained following the uneventful administration of 100 cc of Isovue-370.
intravenous contrast. An acquisition of the chest abdomen and pelvis was
then acquired utilizing a flash acquisition. Sagittal and coronal thin
MIP reconstructions were generated and reviewed.
In accordance with CT policies/protocols and the ALARA principle,
radiation dose reduction techniques (such as automated exposure control,
adjustment of mA/kV according to patient size and/or iterative
reconstruction technique) were utilized for this examination.
*
Aortic annular and vascular measurements will be generated within a
separate report.
The body of the report:
FINDINGS:
VASCULAR:
There is a left-sided 3 vessel aortic arch. No aortic aneurysm,
dissection, or intramural hematoma. There are mild ascending aortic
calcifications.
There are moderate calcified and noncalcified atherosclerotic plaques in
the aorta and its major branches. There is severe stenosis of the
bilateral subclavian arteries secondary to bilateral cervical ribs.
Significant calcification and thickening seen about the aortic valve
leaflets, consistent with known aortic stenosis. Aortic valve is
tricuspid.
*
Heart: An atrial diverticulum is noted about the intra-atrial septum.
Slitlike structure about the septum is suggestive of a PFO. Patient is
status post CABG, with patent LIMA to LAD graft as well as 2 left-sided
patent aortocoronary bypass grafts. No right-sided bypass graft
identified. There is no significant pericardial effusion.
*
Pulmonary Arteries:The pulmonary arteries are normal in caliber. No
definite pulmonary artery filling defect identified.
*
There is advanced atherosclerosis throughout the abdominal aorta with
multifocal ulcerating plaque and a penetrating atherosclerotic ulcer in
the infrarenal aorta (location -480.5).
The celiac artery, SMA and IMA are patent.
One right renal artery and one left renal artery are identified. There is
moderate stenosis at the right renal ostium with poststenotic dilatation.
*
Advanced atherosclerotic changes are seen in the bilateral iliofemoral
arteries, with moderate to severe stenoses in the bilateral common iliac
arteries
*
*
CT CHEST:
Thoracic Inlet: Evaluation of the thyroid gland is limited due to beam
hardening. No supraclavicular lymphadenopathy.
Mediastinum / Hila: No pathologically enlarged lymph nodes. The esophagus
is patulous.
Chest wall: Normal.
*
Lungs / Airways: There are emphysematous changes most pronounced in the
upper lobes. Clustered groundglass opacities in the periphery of the left
upper lobe are likely infectious/inflammatory. There is dependent
atelectasis and peripheral reticulation throughout the bilateral lungs.
Central airways are patent without suspicious filling defects.
Pleural Space: There is no significant pleural effusion. No pneumothorax
is seen.
*
CT ABDOMEN / PELVIS:
Liver: Unremarkable.
Gallbladder: Normal.
Bile Ducts: Normal.
Pancreas: No suspicious pancreatic mass.
Spleen: Unremarkable.
GI Tract: Unremarkable.
*
Kidneys: Symmetric perfusion. No hydronephrosis or suspicious renal
masses.
Adrenals: No discrete adrenal nodules.
*
Lymph nodes: No pathologically enlarged lymph nodes.
*
Pelvic Organs: There is prostatomegaly.
Bladder: Diffuse wall thickening is likely related to chronic outlet
obstruction.
Miscellaneous: No significant free fluid.
Abdominal Wall: Unremarkable.
*
Bones: Sternotomy wiring is intact. There are multilevel degenerative
changes throughout the visualized spine. No acute fractures.
*
IMPRESSION:
*Severe stenoses of the bilateral subclavian artery secondary to cervical
ribs. Advanced atherosclerosis of the abdominal aorta and iliofemoral
arteries, with moderate to severe stenoses in the bilateral common iliac
arteries and penetrating atherosclerotic ulcer in the infrarenal aorta.
*Status post CABG with patent LIMA to LAD and 2 patent left sided
aortocoronary bypass grafts.
*Aortic valve thickening and calcification, compatible with known aortic
valve stenosis. Please see separate report for preprocedural TAVR
measurements.
I understand the ECG gating is bundled into the 75574, right? Would you bill all three CTA codes? If not, can you guide me to any literature saying so?
Thank you!
Here is an example:
EXAM: CT TAVR W/CONTRAST-TG #/##/2018
*
HISTORY: ##-year-old male with aortic stenosis undergoing preprocedural
evaluation and planning for TAVR.
*
TECHNIQUE: After scout images, a noncontrast gated scan of the heart and
nongated acquisition of the chest abdomen pelvis was acquired. Using
retrospective dose modulated ECG gating, CT angiography of the heart, was
obtained following the uneventful administration of 100 cc of Isovue-370.
intravenous contrast. An acquisition of the chest abdomen and pelvis was
then acquired utilizing a flash acquisition. Sagittal and coronal thin
MIP reconstructions were generated and reviewed.
In accordance with CT policies/protocols and the ALARA principle,
radiation dose reduction techniques (such as automated exposure control,
adjustment of mA/kV according to patient size and/or iterative
reconstruction technique) were utilized for this examination.
*
Aortic annular and vascular measurements will be generated within a
separate report.
The body of the report:
FINDINGS:
VASCULAR:
There is a left-sided 3 vessel aortic arch. No aortic aneurysm,
dissection, or intramural hematoma. There are mild ascending aortic
calcifications.
There are moderate calcified and noncalcified atherosclerotic plaques in
the aorta and its major branches. There is severe stenosis of the
bilateral subclavian arteries secondary to bilateral cervical ribs.
Significant calcification and thickening seen about the aortic valve
leaflets, consistent with known aortic stenosis. Aortic valve is
tricuspid.
*
Heart: An atrial diverticulum is noted about the intra-atrial septum.
Slitlike structure about the septum is suggestive of a PFO. Patient is
status post CABG, with patent LIMA to LAD graft as well as 2 left-sided
patent aortocoronary bypass grafts. No right-sided bypass graft
identified. There is no significant pericardial effusion.
*
Pulmonary Arteries:The pulmonary arteries are normal in caliber. No
definite pulmonary artery filling defect identified.
*
There is advanced atherosclerosis throughout the abdominal aorta with
multifocal ulcerating plaque and a penetrating atherosclerotic ulcer in
the infrarenal aorta (location -480.5).
The celiac artery, SMA and IMA are patent.
One right renal artery and one left renal artery are identified. There is
moderate stenosis at the right renal ostium with poststenotic dilatation.
*
Advanced atherosclerotic changes are seen in the bilateral iliofemoral
arteries, with moderate to severe stenoses in the bilateral common iliac
arteries
*
*
CT CHEST:
Thoracic Inlet: Evaluation of the thyroid gland is limited due to beam
hardening. No supraclavicular lymphadenopathy.
Mediastinum / Hila: No pathologically enlarged lymph nodes. The esophagus
is patulous.
Chest wall: Normal.
*
Lungs / Airways: There are emphysematous changes most pronounced in the
upper lobes. Clustered groundglass opacities in the periphery of the left
upper lobe are likely infectious/inflammatory. There is dependent
atelectasis and peripheral reticulation throughout the bilateral lungs.
Central airways are patent without suspicious filling defects.
Pleural Space: There is no significant pleural effusion. No pneumothorax
is seen.
*
CT ABDOMEN / PELVIS:
Liver: Unremarkable.
Gallbladder: Normal.
Bile Ducts: Normal.
Pancreas: No suspicious pancreatic mass.
Spleen: Unremarkable.
GI Tract: Unremarkable.
*
Kidneys: Symmetric perfusion. No hydronephrosis or suspicious renal
masses.
Adrenals: No discrete adrenal nodules.
*
Lymph nodes: No pathologically enlarged lymph nodes.
*
Pelvic Organs: There is prostatomegaly.
Bladder: Diffuse wall thickening is likely related to chronic outlet
obstruction.
Miscellaneous: No significant free fluid.
Abdominal Wall: Unremarkable.
*
Bones: Sternotomy wiring is intact. There are multilevel degenerative
changes throughout the visualized spine. No acute fractures.
*
IMPRESSION:
*Severe stenoses of the bilateral subclavian artery secondary to cervical
ribs. Advanced atherosclerosis of the abdominal aorta and iliofemoral
arteries, with moderate to severe stenoses in the bilateral common iliac
arteries and penetrating atherosclerotic ulcer in the infrarenal aorta.
*Status post CABG with patent LIMA to LAD and 2 patent left sided
aortocoronary bypass grafts.
*Aortic valve thickening and calcification, compatible with known aortic
valve stenosis. Please see separate report for preprocedural TAVR
measurements.