Compliance Question of the Week – Radiology

When performing a breast ultrasound on a patient with a known history of cancer, we are being asked to also scan the supraclavicular, infraclavicular and infra-mammary nodes. How would we code this additional scan?

I have a follow-up question regarding the instructions given in the April 23 radiology question for the venous duplex scans of both the upper and lower extremities. The instructions were to add modifier -59 to the second 93970 to indicate that it was a different body area. This follows standard coding guidelines; however, we received a denial from our MAC (WPS or NGS) indicating we were to use modifier -76 based on CMS Transmittal 1702 (https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1702CP.pdf) which states:

For only those instances that involve more than one bilateral procedure and are medically necessary and appropriate, hospitals are advised to report the procedure code with a modifier -76 (repeat procedure or service by same physician) in order for the claim to process correctly. Appending modifier -76 to one of the reported bilateral HCPCS code indicates that the bilateral procedure or service was repeated on the same day for the same patient.

Is this information still applicable?

We are interested in developing an order set with specific codes when providers want to rule out obstruction of arteries and veins prior to heart catheterization. Which of the following would make more sense?

Order/charge out arterial duplex/venous duplex with reduced modifiers since they are only looking at the groins.
Use a “pre-line” order that involves the internal jugular vein, subclavian vein, and common femoral vein but eliminates the jugular and subclavian veins and adds the common femoral arteries.
Order/charge out arterial duplex/venous duplex with reduced modifiers since they are only looking at the groins.

Use a “pre-line” order that involves the internal jugular vein, subclavian vein, and common femoral vein but eliminates the jugular and subclavian veins and adds the common femoral arteries.

When we have a patient who has a lower extremity and upper extremity venous duplex scan (CPT®s 93970 and/or 93971), we sometimes (although rarely) evaluate for an upper and lower deep vein thrombosis (DVT). How should we bill if we image all four extremities?

What codes would be used for a non-PET myocardial perfusion scan?

My radiologist is reading fluoroscopy films done in the operating room by another physician. Can my radiologist bill for the fluoroscopy (76000), or should we bill for the area being imaged (such as a chest X-ray) with a 52 modifier since the fluoroscopy isn’t being performed?

What is the ICD-10 code to use for an unspecified lump in the right breast identified at the 9:00 position? The 9:00 position is not in one of the four quadrants nor is it in the axillary tail or subareolar locations.

A patient came in for a whole body thyroid cancer metastases imaging and a SPECT/CT of the neck and chest also was performed. What CPT® code are we to assign here since there is no CPT code for the SPECT/CT?

When it is appropriate to bill 77073—bone length studies (orthoroentgenogram, scanogram)—with the following codes?
73562 Radiologic examination, knee; 3 views
73564 Radiologic examination, knee; complete, 4 or more views

If a patient is having a computed tomography (CT) abdomen/pelvis without contrast (CPT® 74176) and the physician orders two doses of Omnipaque 3,000 mg (Q9967) in 500 ml of sterile water to be administered orally 30 minutes before the exam, can we bill separately for the contrast? If so, is the contrast billed per ml? (I understand that whether intravenous contrast was injected determines coding for CT. Only intravenous administration of contrast changes the code sets. Oral and/or rectal contrast is not billable as a “with contrast” study.)

Can we bill separately for the oral contrast if the test is ordered as a CT abdomen/pelvis with and without contrast (CPT 74178)? I would think we cannot bill separately for the oral contrast in this situation because the IV contrast would already be billed.

We have had many discussions on when it is appropriate to use 76706—ultrasound, abdominal aorta, real time with image documentation, screening study for abdominal aortic aneurysm (AAA). Can we still assign this code if the radiology report does not document screening for AAA for the history and only states patient with abdominal pain but the final impression states no evidence of AAA?

Can you provide me with coding information for liver ultrasound with Lumason contrast?