Compliance Question of the Week – Radiology

I would like a second opinion on billing for a limited extremity ultrasound (US) and an aspiration with US guidance. These are documented on the same report without separation. I feel that although the criteria for a limited 76882 are met (i.e., imaging of the joint and showing effusion), the procedure is really performed for needle placement, which would make it inclusive. Could you please review the report below and give me your opinion?

What would be the code when a physician performs selective angiography of the anterior and posterior superior pancreaticoduodenal artery?

Do insurers require an inconclusive SPECT myocardial perfusion scan prior to performing a PET myocardial perfusion scan?

Would I report 49400 and 74190 for a peritoneal dialysis catheter check?

One of our patients had a lung ventilation-perfusion scan with SPECT/CT Imaging. How is this coded?

We received an order for a computed tomography (CT) of the right ankle without contrast material and a CT of the right foot w/o on the same patient. Can we charge for both procedures separately if we separately scan each part? I know they both use the same CPT® code 73700 (CT, lower extremity; without contrast material). If we were to scan the entire region (toes to mid leg) in one scan I assume in that case we would only charge 73700 one time.

What code would we assign for a magnetic resonance imaging (MRI), face only? Should we add modifier -52 on 70540 or bill a maxillofacial MRI?

What is the CPT® code for lung shunt fraction liver mapping? Here is part of the documentation below. There is more detail in the report but these lung shunt fraction studies for hepatic masses seem to be common.

Patient received 5.2 MCI Technetium 99M MAA. Multiple static views of the lungs and abdomen were obtained. The geometric mean of the lungs and liver were obtained. The lung shunt fraction was obtained.

Does the radiologist have to be in the room with the gynecologist while the injection and exam are performed in order for the hospital to charge the following CPT® code in the outpatient department?

74740 Hysterosalpingography, radiological supervision and interpretation

We perform treatment-simulation planning in our magnetic resonance imaging (MRI) for brain and prostate radiation procedures. The radiologist does not interpret these exams; they are performed just to send the images to other systems for their use. Is there an appropriate charge code for this type of imaging? In the past we have used 76498 but our charge-master coordinator does not think that is appropriate. Any guidance you can give is appreciated.

I keep hearing about new modifier QQ. What is this modifier used for, and is its use mandatory?

Is it appropriate to bill for a 3D post-processing charge (76377) for the computer-aided detection (CAD) portion of the prostate magnetic resonance imaging (MRI) since the computer generates a 3-D model to calculate perfusion curves?