Radiology Question for the Week of November 7, 2022

Question:

In many instances, physicians are ordering a CT to rule out a pulmonary embolism. Shouldn’t these be performed as CTA exams if they are checking the vessels?

Answer:

The clinical indication is not the determining factor in CPT® code selection. Whether to code for a CT exam vs. a CTA exam will depend upon the technique utilized. CPT Assistant addressed this area of confusion in its June 2009 issue and reiterated the technique for each of these exams:“ When CT scanning of the chest is performed using contrast-enhanced dynamic-timed imaging, and only axial and 2D reformatted images are obtained and reviewed, then such a service would be reported using code 71260, Computed tomography, thorax; with contrast material(s). CT angiography (CTA) is a distinct type of CT service that includes three-dimensional (3D) angiographic postprocessing. When a chest CTA is specifically ordered, or CT is ordered for a noncardiac vascular indication necessitating such 3D angiographic postprocessing, the service should be reported using CPT code 71275, Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing. Three-dimensional postprocessing techniques commonly include maximal imaging projection (MIP) reconstructions, but a variety of other 3D techniques exist as well (see Clinical Examples in Radiology, Volume 3, Issue 4, Fall 2007). If the order is for “Chest CT” and the radiologist feels CTA is clinically necessary, documentation of the need for 3D imaging is strongly recommended.” To assign code 71275, the report must clearly document that a 3D technique was used for image post-processing.

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