Compliance Question of the Week – Radiology

Can you provide a definition for “digitally subtract” when it comes to imaging? And does this procedure have an impact on code assignments?

Would the following scenario code out as an abdominal aortography with bilateral runoff with 75625 and 75716? Or would it be 75630 and 75774 as the department has charged? Selective catheterizations into the arteries were not described.

For a lower extremity revascularization procedure, access with a 5-french sheath was inserted into the right femoral artery and a sequential digital subtraction angiography was performed at multiple levels of the right lower extremity.

Next, a 5-french pigtail was advanced through the sheath over a standard wire into the distal abdominal aorta above the bilateral iliac ostium. From this position, a digital subtraction angiogram was obtained after the distal abdominal aorta.

A glidewire was advanced through the pigtail catheter into the distal left superficial femoral artery (SFA). The pigtail catheter was switched out for a straight tapered glide catheter advanced into the left common femoral artery, and multiple digital subtracted angiograms were obtained of the left lower extremity at multiple levels. Thereafter, endovascular revascularization proceeded.

I assume that when magnetic resonance imaging (MRI) of the liver, regardless of the clinical indication, and the other abdominal structures are defined in the report, we should append modifier 52. If I understand the rules correctly, to meet the intent of 74181 all organs must be evaluated, anything less requires modifier 52 depending on the payer.

What is the correct code to report for a PET/MRI fusion?

We performed a whole-body octreotide exam with SPECT. Since the imaging took place over two days, would we assign 78804 and 78803? Is the time frame the only difference between 78804 and 78802?

Often times computed tomography (CT) scans are performed on multiple anatomical areas (such as cervical, thoracic and lumbar spine). Can CPT code 76377 be reported up to one time for each base imaging code?

What should we be coding when a patient presents with an order for bilateral complete knee imaging with standing AP views?

What work is typically included in a computed tomography (CT) of the abdomen and CT of the pelvis?

My nuclear medicine tech is being asked to do a procedure for a sestamibi injection without any parathyroid imaging. The intent is to locate the parathyroid prior to surgery so it is similar to a sentinel node injection. Is there a diagnostic nuclear isotope injection code, or should we use an unlisted procedure code?

Our physicians use scribes for documentation. Does Medicare require that the scribe sign the medical record?

The description for the tomosynthesis code 77063 is “screening digital breast tomosynthesis, bilateral.” If only a unilateral is perform, do we add a 52 modifier to this code?

We were asked to do a tibia/fibula x-ray on an infant. Is the appropriate code 73592?