Compliance Question of the Week – Radiology

What is the correct CPT® code for PET/CT heart for sarcoidosis using FDG?

We are performing intrathecal chemo administration and assigning code 96450. We are also doing fluoro for needle guidance, which would be assigned 77003. However, with the new 2017 CPT® guideline, 96450 is not a primary procedure code to 77003. How should we bill for the fluoro guidance?

What would be the correct CPT® code to bill for an I131 therapy for hyperthyroidism? All we do in this case is dose the patient with the prescribed dose for treatment.

Would it be a contrast-only MRI/MRA scan if localizer scans only are done pre-contrast and most of the diagnostic imaging is done only after contrast administration? In other words, would a non-contrast followed by contrast scan code only apply if additional imaging beyond localizers was done after contrast?

How would you code the following bone scan study?
“Findings: a focus of increased uptake in the medial left clavicle corresponding with fracture seen on CT. Anterior rib uptake bilaterally is probably due to accidental trauma and similar-appearing Steele bone scan. Right posterior 11th rib lesion is without obvious change. Hip prostheses noted. No definite new bone metastases. Conclusion: the lesion is in the left medial clavicle corresponds to benign appearing fracture on CT. Stable right posterior 11th rib lesion.”

We just started imaging, in nuclear medicine, after we inject the isotope, in the breast, for sentinel node identification. We previously assigned 38792 (injection procedure; radioactive tracer for identification of sentinel node), but now that we are imaging is the correct CPT® to use 78195?

The patient had a right breast ultrasound, and we billed CPT® code 76641 with modifier –RT. The insurer denied this claim due to the modifier. Doesn’t the breast ultrasound require a modifier?

Is there a CPT® code to use when performing a chest and abdominal single-view on an infant located in the neonatal ICU? We now use 71010 (radiologic examination, chest; single view, front) and just include a reading of the abdomen within the chest report. Is this correct, or would it be appropriate to do the same view as described and send the same view to two separate orders (chest 71010 and abdomen 74000)?

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?