I do Radiology coding and we have had to deal with the same issue. The way it's been explained to our dept. is that all CTs are basically reconstructions. We have explained to our physicians the same thing you told your doctor. The code for 76376(77) is supposed to cover a more extensive image processing. This is what CPT Assistant says about it:
Three-dimensional rendering coding clarification
CPT Assistant, December 2005 Page: 7 Category: Coding Consultation
3D Rendering Coding Clarification - 76376-76377
For CPT 2006, code 76375, Coronal, sagittal, multiplanar, oblique, 3-dimensional and/or holographic reconstruction of computed tomography, magnetic resonance imaging, or other tomographic modality, which described 3-dimensional (3D) image reconstruction, has been deleted. In its place, two new codes have been established to report 3D rendering of computed tomography, magnetic resonance imaging, ultrasound, and other tomographic modalities. They are as follows:
76376 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; not requiring image postprocessing on an independent workstation
76377 requiring image postprocessing on an independent workstation
The 3D image rendering codes were added in CPT 2006 to accurately reflect the levels of complexity of image postprocessing and rendering currently being performed. Advances in technology have, in many situations, expedited 2-dimensional (2D) image reformatting so it can now be performed rapidly by a technologist without a separate workstation or the need to take a scanner off-line for image processing. On the other hand, complex 3D image rendering often requires extensive independent workstation processing by a a supervising physician and specially trained technologist. A few applications can be performed on the scanner using optional and expensive hardware and software.
Additionally, with the evolution of scanner capabilities to produce 2D reformatting virtually in real time, the 2D reformats are now included in the base procedure code and not separately reported. The new 3D rendering codes address complex renderings such as shaded surface rendering, volumetric rendering, maximum intensity projections (MIPs), fusion imaging, and quantitative analysis (segmental volumes and surgical planning).
An exclusionary parenthetical note was added following each new code to indicate the procedures in which 3D rendering is considered an inherent component and would not be separately reported.
The following reflects the procedures that are not to be reported in conjunction with codes 76376 and 76377:
Computed tomographic angiography of the head, neck, chest, pelvis, upper and lower extremity, abdomen, and abdominal aorta and bilateral iliofemoral lower extremity vessels (70496-70498, 71275, 72191, 73206, 73706, 74175, 75635)
Magnetic resonance angiography of the head, neck, chest, spinal canal, pelvis, upper and lower extremity, and abdomen (70544-70549, 71555, 72159, 72198, 73225, 73725, 74185)
Positron emission tomography tumor imaging (78811-78816)
Computed tomographic colonography (virtual colonoscopy) (0066T-006T)
Although not reflected in the parenthetical notes for 2006, it would not be appropriate to report codes 76376 and 76377 in addition to any code from the Nuclear Medicine series (78000-78999).
The CPT Editorial Panel has approved the addition of a parenthetical note to the entire range of nuclear medicine codes excluding the use of 76376 and 76377 for publication in CPT 2007.
