Compliance Question of the Week – Radiology

When performing bilateral breast cyst aspirations, do we use 19000 and 19001 or 19000 x 2?

Our radiologist interpreted a right upper and lower quadrant (RUQ and RLQ) ultrasound ordered by the ER physician. The spleen was not examined so we cannot code a 76700 exam. Is it appropriate to code 76705 twice and add a 59 modifier to the second one?

If a patient is having an ultrasound-guided breast biopsy, codes 19083, as well as an ultrasound-guided lymph node biopsy, 76942, 38505, is it appropriate to code all three codes? Is a modifier allowed on the 76942 since it was for a different lesion?

We are adjusting off quite a few computed tomography (CT) scans that are performed to follow up a cancer diagnosis after treatment is complete. Our state’s local coverage determination (LCD) covers the cancer diagnosis code but does not cover the “history of” the specific cancer nor does it cover Z08 for completion of treatment. Is there any compliant way around this denial? For instance, can we bill the cancer diagnosis that is covered even though the report states no evidence of recurrence or metastasis?

We are beginning to perform abbreviated breast screening magnetic resonance imaging (MRI) scans without and with/without contrast. They have fewer sequences and take about half the amount of time of a regular breast MRI. If done without contrast followed by contrast administration and
imaging, would we report CPT code 77049-52 or an unlisted CPT code?

We performed a sentinel node localization on a patient. We injected the radiopharmaceutical, did a lymphangiogram, then sent the patient to surgery. We coded 78195 and 38792 but are getting denied. Do you know what the problem is?

We performed a lumbar three-phase bone scan with SPECT. I’m being told to code 78315 and 78803. Is this correct? I think I should just code 78315.

Is it appropriate to separately report a specimen radiograph performed after a breast localization procedure?