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Do not bill lumbar spine CT with abdominal/pelvis CT

APCs Weekly Monitor, November 10, 2006

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Do not bill lumbar spine CT with abdominal/pelvis CT

QUESTION: Our staff performed an abdominal/pelvis CT. The physician reviewed the study with the radiologist and ordered a lumbar spine CT. Because we have a multi-slice CT scanner, our staff did not have to physically rescan the lumbar. Our staff took the raw data, redid the image processing with a multitude of changes, and using different algorithms and reconstruction planes came up with a lumbar spine scan that produced the same images as a separate scan of the patient.

The radiologist dictated a CT lumbar exam. Various people have told me that they charge a lumbar CT in this instance because the whole exam is redone, which turns it into a separate and different exam with the full number of images-not just a reconstruction of a particular area.

We considered using the 3-D rendering codes (76376 or 76377) to report this service, but our radiologist stated the following: "None of these (codes) fit. We did not perform the 3-D. We simply did everything it would take to create a completely different exam. Our applications people for CT said that we should charge for the new exam when this is the case. It is not rendering or processing the exam to get more detailed for that study. Instead, it is turning the exam into a different study."

Should we bill this lumbar reprogramming as a separate procedure?

ANSWER: No. Do not bill this lumbar reprogramming as a separate procedure since it does not involve a patient, nor does it involve additional room/work station or setup. Also, there are negligible labor costs and the costs related to a couple extra sheets of film, etc., are insignificant.

While many carriers may allow the Part B professional fees for the interpretation of the film, the additional facility time and costs not already covered by the underlying procedure reimbursement are insignificant. Providers should not bill for a lumbar CT performed on the same day as an abdominal/pelvic CT, since there is no additional work to justify payment. In addition, the CPT Manual specifically does not allow you to bill these two procedures together.

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