Compliance Question of the Week – Radiology

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?

I know that in order to bill a complete pelvic ultrasound the measurement of the uterus, adnexal structures, endometrium, and any pelvic pathology must have been assessed and documented, but do both ovaries have to be documented?

For example, the doctor says the left ovary could not be well seen and lists what he saw on the right ovary as well as the uterus and endometrium measurements. Can a pelvic complete be charged?

If we have an ultrasound of the back (soft tissue) or any part of the body (not including head, neck or extremities), we use code 76999—unlisted ultrasound procedure (e.g., diagnostic, interventional). We have one today looking at a mass on the soft tissue area of the T-spine. Last week we had a soft tissue of the chest. Just making sure there is not another code you feel we should be using.

The patient had a right breast ultrasound, and we billed the following CPT® code with
modifier -RT:

76641 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete

The insurer denied this claim due to the modifier. Doesn’t the breast ultrasound require a modifier?