Wiki Radiology Question CT Orbit & CT Head

[maeliza]

I have two radiology reports that was done for a patient that had trauma to his head and swelling around the orbital area. We billed 70480 & 70450 per the reports supports both cpt codes and we applied a 59 modifier to cpt code 70450. We always have one code that deny 70480 . Is is correct to bill these codes together and just proceed with an appeal to the insurance company or does it just depends on how the dicated report reads. Just need some feed back...

The CCI edits states that these are mutually exclusive.
Code 70480 (RVU: 9.3) and 70450 (RVU: 5.81) are mutually exclusive. You may typically only bill one of them. You may unbundle them only if you can justify the use of an appropriate modifier. If you are unable to justify the use of a modifier, you should bill 70480 (RVU: 9.3) alone because it has a higher RVU than 70450 (RVU: 5.81). If you try to bill them together without modifier justification, code 70480 (RVU: 9.3) is at risk. Medicare will reimburse for 70450 (RVU: 5.81) at the lower RVU instead.

Thanks,
Maeliza

 

[jgf-CPC]

There should be 2 separate reports for the head and the orbits. I would appeal if you have 2 reports and you can show that it was medically necessary.

 

[cjacobs]

If there is only one report, the head is included in the code 70480. I agreed with the previous statement, if there are two separate reports then I would do appeal as well.

 

[Carlyle Diaz]

Is a CT head different than a CT brain?

http://www.acr.org/~/media/ACR/Docu... CT MRI Coding on Adjacent Anatomic Areas.pdf

Code 70450 says CT of head OR brain, thus making a distinction as opposed to head/brain or head and brain. The above link from the American College of Radiology had an interesting take and it makes me wonder if CT head and CT orbits do bundle but CT brain and CT orbits don't bundle thus allowing for reimbursement for both with modifier 59. I wish I knew the answer.