Coding

Ordered as a bilateral complete breast ultrasound, what is the proper code assignment? Complete real-time ultrasonography of the left breast was performed. Dense tissue is seen throughout. A 4 mm simple cyst is identified at the 12:00 position, 2 cm from the nipple. No concerning solid mass is seen in the left breast. A prominent left axillary lymph node measuring 9 mm in short axis is noted. Ultrasonography of the right chest wall and axilla was performed. No concerning lesion is identified.

If a nuclear medicine planar scan is performed of the knees for a possible infection, would this be coded as 78300 or 78800? Does it matter which radiopharmaceutical was used? Nuclear medicine technologists are saying it should be coded as an infection scan using 78800. Their point is that an infection radiopharmaceutical is being used, so it should be coded as 78800. However, when I read the heading of the section for 78800, it states “(for specific organ, see appropriate heading),” which would be the musculoskeletal system. Since a limited planar scan is present in that section, I believe 78300 should be used.

On the hospital side, during an MAA mapping study, the doctors are using a device called a TriNav catheter to temporarily occlude the vessel. To be clear, they are not performing an embolization at this point. Historically, we have billed for catheterization and imaging, but with the release of the C9797 code, we are now being instructed to bill C9797 during the MAA mapping, even when no true embolization is performed. The patient returns a few weeks later for the Y90 treatment, which also involves the use of the TriNav catheter. At that time, I billed the procedure with C9797. What is the correct way to bill for the MAA mapping session on the hospital side?

If a screening Mammogram (77067) and tomosynthesis (77063) are performed unilaterally, should Modifier 52 be placed on both CPTs®?

For proper reporting of CTA exams, there is a well-documented list of acceptable 3D techniques to satisfy the code requirement. These are 3D MIP, surface-shaded rendering, and volume rendering, as well as “other 3D techniques.” We’ve come across dictations that state 2D MIPs. Is this a type of 3D technique?

In regard to last week’s question, should a study be initiated but not completed, what modifier would we report with the code?