September 9, 2024

CT Scans

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By Janine Mothershed

Understanding CPT Codes for CT Scans: A Comprehensive Guide

In medical coding, accurately documenting and coding CT (computed tomography) scans is crucial for proper billing and reimbursement. The Current Procedural Terminology (CPT) codes for CT scans are used to describe the specific procedures performed, ensuring that healthcare providers are reimbursed appropriately for their services.

A computed tomography (CT) scan is a medical imaging procedure that uses X-rays and computers to create detailed cross-sectional images of the inside of the body. CT scans are also known as CAT scans, which stands for “computed axial tomography”.

Here are some things to consider when coding CT scans:

Modifier use
Organizations should not unbundle a CT and CTA and bill for both studies with a modifier unless the previously outlined criteria are met.

Modifiers: Some commonly used modifiers for CT scans include:

  • Modifier 26: This modifier is used to indicate that the radiologist is providing only the professional component of the CT scan service. This means that the radiologist is only interpreting and reporting the results of the scan, and did not perform the scan itself. This modifier is typically used when the technical component of the scan is performed by a different provider, such as a hospital or imaging center.
  • Modifier TC: This modifier is used to indicate that the provider is providing only the technical component of the CT scan service. This means that the provider is only responsible for the equipment, supplies, and personnel necessary to perform the scan, and did not interpret or report the results of the scan. This modifier is typically used when the professional component of the scan is performed by a different provider, such as a radiologist.
  • Modifier 52: Indicates a reduced service was performed
  • Modifier 53: Indicates a service was discontinued due to extenuating circumstances
  • Modifier 59: Indicates a separate and distinct service was performed during the same encounter

Contrast: When a CT scan is performed with contrast, the provider must document the administration method. This can be intravascular, intraarticular, or intrathecal.

CPT codes: Some CPT codes for CT scans include 70450, 73700, 74150, 74160, and 74170

This guide provides an overview of CPT codes for CT scans, helping medical coders understand the various codes and their applications.

Billing for multiple exams
To charge for both a CT and a CTA, the treating physician must order both exams, both exams must be medically necessary, and both must be documented separately.
Global periods
 A global period is a set time frame that includes all services related to a surgical procedure or operation.
 This includes the preoperative period, the surgery itself, and the postoperative period. 

The length of the global period depends on the type of surgery performed:
  • Major surgery: The global period is 90 days
  • Minor surgery: The global period is 10 or 0 days 
A physician cannot bill for related office visits during the global period. The global surgery fee includes all related services and supplies, such as:
  • Preoperative visits
  • Intraoperative care
  • Postoperative care, including removal of sutures, staples, casts, and drains
  • Supplies for postoperative complications

https://www.aapc.com/blog/33670-what-the-global-period-does-and-does-not-include/

https://www.aapc.com/blog/46373-your-quick-guide-to-the-global-surgical-package/

Bundling:

The National Correct Coding Initiative (NCCI) from the Centers for Medicare and Medicaid Services (CMS) establishes bundling rules for CT scans. These rules are intended to prevent overpayment for services that are part of a more comprehensive service. Some examples of CT scan bundling rules include: 

  • Less extensive scans bundled into more extensive scans
    If a more extensive CT scan is performed on the same site as a less extensive CT scan, the less extensive scan is bundled into the more extensive scan

General Principles for CT Scan Coding

  1. Anatomical Focus: CPT codes for CT scans are often categorized based on the anatomical area being examined. It’s essential to select the code that precisely reflects the body part or region scanned.
  2. Contrast Use: Some codes specify whether a contrast agent was used. Contrast-enhanced CT scans may have different codes compared to non-contrast scans.
  3. Scan Type: CPT codes can differ based on whether the scan is performed with or without contrast, and whether it is a single or multiple-region scan.
  4. Technical and Professional Components: CPT codes often include both the technical component (the actual performance of the scan) and the professional component (the interpretation of the scan). Some codes may be used exclusively for one component or the other.

Common CPT Codes for CT Scans

  1. CT of the Head and Brain
    • 70450: CT scan of the head or brain without contrast.
    • 70460: CT scan of the head or brain with contrast.
    • 70470: CT scan of the head or brain with and without contrast.
  2. CT of the Facial Bones
    • 70250: CT scan of the facial bones or sinuses without contrast.
    • 70260: CT scan of the facial bones or sinuses with contrast.
    • 70270: CT scan of the facial bones or sinuses with and without contrast.
  3. CT of the Chest
    • 71250: CT scan of the chest without contrast.
    • 71260: CT scan of the chest with contrast.
    • 71270: CT scan of the chest with and without contrast.
  4. CT of the Abdomen and Pelvis
    • 74150: CT scan of the abdomen and pelvis without contrast.
    • 74160: CT scan of the abdomen and pelvis with contrast.
    • 74170: CT scan of the abdomen and pelvis with and without contrast.
  5. CT of the Spine
    • 72125: CT scan of the cervical spine without contrast.
    • 72126: CT scan of the cervical spine with contrast.
    • 72127: CT scan of the cervical spine with and without contrast.
    • 72128: CT scan of the thoracic spine without contrast.
    • 72129: CT scan of the thoracic spine with contrast.
    • 72130: CT scan of the thoracic spine with and without contrast.
    • 72131: CT scan of the lumbar spine without contrast.
    • 72132: CT scan of the lumbar spine with contrast.
    • 72133: CT scan of the lumbar spine with and without contrast.
  6. CT of the Extremities
    • 73200: CT scan of the extremity (shoulder or arm) without contrast.
    • 73201: CT scan of the extremity (shoulder or arm) with contrast.
    • 73202: CT scan of the extremity (shoulder or arm) with and without contrast.
    • 73700: CT scan of the lower extremity (hip or knee) without contrast.
    • 73701: CT scan of the lower extremity (hip or knee) with contrast.
    • 73702: CT scan of the lower extremity (hip or knee) with and without contrast.

Special Considerations

  1. Virtual Colonoscopy:
    • 74261: CT scan of the colon (virtual colonoscopy) without contrast.
  2. CT Angiography:
    • 71275: CT angiography of the chest with contrast.
    • 74174: CT angiography of the abdomen and pelvis with contrast.
  3. Cardiac CT:
    • 75571: CT scan of the heart with contrast for coronary artery imaging.

Accurate coding for CT scans requires a detailed understanding of the specific CPT codes and the nuances of each scan type. By following this guide, medical coding professionals can ensure precise documentation and appropriate reimbursement for CT scan services. Always stay updated with the latest CPT code changes and guidelines to maintain accuracy in coding practices.

https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c13.pdf

 

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