November 16, 2009
How to Code for CT Angiography
By Anthony McCallum, CPC, CCS, CIRCC, CPC-I
Radiology Today
Vol. 10 No. 18 P. 12
CT angiography (CTA) provides a quick and cost-effective means of diagnosing vascular disorders, diseases, and injuries. CTA technology employs high-resolution, high-speed CT with a rapid intravenous injection of a contrast medium to generate images of vascular structures, much like that obtained via catheter-based angiography.
Technological advances in scanners have significantly improved the visualization of targeted vessels. Although CTA is noninvasive and has proven to be a very useful tool in vascular imaging, it has its own associated risks, including ionizing radiation exposure and allergic reactions to the contrast materials.
The ACR CTA practice guidelines indicate that it is a useful procedure for the detection and characterization of vascular diseases and anatomy. Further, CTA may be a primary modality for detecting disease or as an adjunctive procedure to better characterize or assess disease changes over a period of time.
Indications for CTA may include the following:
• aortic disease and aneurysms of the abdomen, chest, and other blood vessels;
• cerebral aneurysms and arteriovenous malformations;
• atherosclerotic disease of the cervical carotids, extremity vessels, and coronary arteries;
• pulmonary embolism;
• renal artery stenosis, preoperative assessment of living potential kidney donors and variant anatomy in renal vessels (eg, accessory renal arteries);
• vascular dissection, intramural hematomas;
• traumatic vascular injury; and
• peripheral artery disease.
Currently, the Centers for Medicare & Medicaid Services does not have a national coverage determination for CTAs. However, the Medicare National Coverage Determinations Manual indicates that such decisions should be made by the local contractors via the local coverage determination (LCD) process or on a case-by-case adjudication. National Government Services, one of the nation’s largest Medicare contractors, currently has an LCD that addresses coronary CTAs only, without listing an LCD for noncoronary CTAs. Coverage determination policies vary; therefore, it is crucial to obtain the appropriate coverage determination policy when coding and appealing denials.
CTA Coding
• 70496, Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing.
• 70498, Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and image postprocessing.
• 71275, Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing.
• 72191, Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing.
• 73206, Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing.
• 73706, Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing.
• 74175, Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and image postprocessing.
• 75635, Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast material(s), including noncontrast images, if performed, and image postprocessing.
Coronary CTA Category 3 Codes
• 0144T, Computed tomography, heart, without contrast material, including image postprocessing and quantitative evaluation of coronary calcium. (Do not report code 0144T in conjunction with codes 0145T to 0151T.)
• 0145T, Computed tomography, heart, with contrast material(s), including noncontrast images, if performed, cardiac gating and 3D image postprocessing; cardiac structure and morphology.
• 0146T, Computed tomography, heart, with contrast material(s), including noncontrast images, if performed, cardiac gating and 3D image postprocessing; computed tomography angiography of coronary arteries (including native and anomalous coronary arteries, coronary bypass grafts), without quantitative evaluation of coronary calcium.
• 0147T, Computed tomography, heart, with contrast material(s), including noncontrast images, if performed, cardiac gating and 3D image postprocessing; computed tomography angiography of coronary arteries (including native and anomalous coronary arteries, coronary bypass grafts), with quantitative evaluation of coronary calcium.
• 0148T, Computed tomography, heart, with contrast material(s), including noncontrast images, if performed, cardiac gating and 3D image postprocessing; cardiac structure and morphology and computed tomographic angiography of coronary arteries (including native and anomalous coronary arteries, coronary bypass grafts), without quantitative evaluation of coronary calcium.
• 0149T, Computed tomography, heart, with contrast material(s), including noncontrast images, if performed, cardiac gating and 3D image postprocessing; cardiac structure and morphology and computed tomographic angiography of coronary arteries (including native and anomalous coronary arteries, coronary bypass grafts), with quantitative evaluation of coronary calcium.
• 0150T, Computed tomography, heart, with contrast material(s), including noncontrast images, if performed, cardiac gating and 3D image postprocessing; cardiac structure and morphology in congenital heart disease.
• +0151T, Computed tomography, heart, with contrast material(s), including noncontrast images, if performed, cardiac gating and 3D image postprocessing, function evaluation (left and right ventricular function, ejection-fraction, and segmental wall motion). (List separately in addition to code for primary procedure.) (Use code 0151T in conjunction with codes 0145T to 0150T.)
For specific information related to indications, limitations, and medical necessity (covered ICD-9 diagnosis codes), see the coverage determination policies with the appropriate payer. Coverage determination policies also may include documentation requirements, utilization guidelines for frequency, and other information relevant to coding and billing specific services.
Coding Tips for CTAs
• Do not separately code CTA of the abdomen, pelvis, and lower extremity (74175, 72191, or 73706) for an aorto-iliofemoral runoff study; only report 75635.
• Upper and lower extremity CTA codes are unilateral; ensure that bilateral procedures are billed in accordance with the appropriate carrier or third-party payers (for instance, using modifiers RT Right side, LT Left side, 50 Bilateral procedure, etc).
• Image postprocessing is included in the CTA procedures; therefore, do not separately report 3D rendering (76376 or 76377) with these codes.
• Injection of contrast material is a part of CTA procedures and therefore is not coded separately. (Do report HCPCS code for the contrast material supply.)
• Do not code 71275 for CTA of the heart or coronary arteries in lieu of the CPT category 3 codes for coronary CTA.
• Do not report CPT 0147T or 0149T with 0144T because the code descriptors already include the quantitative evaluation of coronary calcium.
— Anthony McCallum, CPC, CCS, CIRCC, CPC-I, is a senior outpatient revenue specialist at the North Shore-Long Island Jewish Health System in New York. He has 19 years of experience in various capacities of the healthcare revenue cycle, including denials management, charge master maintenance, coding audits, and education, and is certified by the American Academy of Professional Coders as a coding instructor and interventional radiology cardiovascular coder.
Resources
• Centers for Medicare & Medicaid Services’ Medicare National Coverage Determinations Manual: www.cms.hhs.gov/manuals/iom/list.asp
• National Government Services’ L25907 Cardiac Computed Tomography and Coronary Computed Tomography Angiography: www.ngsmedicare.com
• ACR Practice Guideline for the Performance and Interpretation of Computed Tomography Angiography (CTA)
