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Clearing up the confusion: CPT codes 76376 and 76377

Radiology Administrator's Compliance and Reimbursement Insider, March 1, 2006

by Stacie L. Buck

If determining whether to bill for two-dimensional (2D) or three-dimensional (3D) reconstructions wasn't confusing enough, the American Medical Association (AMA) deleted code 76375 and introduced two new codes to describe 3D rendering in 2006.

The new codes are

  • 76376 —3D rendering with interpretation and reporting of CT, magnetic resonance imaging (MRI), ultrasound, or other tomographic modality; not requiring image postprocessing on an independent workstation
  • 76377 —3D rendering with interpretation and reporting of CT, MRI, ultrasound, or other tomographic modality; requiring image postprocessing on an independent workstation

    The deleted code 76375 was used for coronal, sagittal, multiplanar, oblique, three-dimensional, or holographic reconstruction of CT, MRI, or other tomographic modality.

    AMA implemented the new codes because changes in technology code 76375 no longer adequately represent current methods of reformatting images. In addition, the new codes came as a result of the overuse of code 76375.

    With the deletion of code 76375, reimbursement for 2D reconstructions will be bundled with the base procedure code as of January 1.

    Although CPT provides instruction about how to use these codes through the parenthetical notes that follow them, questions still remain.

    Method of reformatting

    Reformatting the images is done either on the acquisition scanner software or at a separate, independent workstation.

    Note: The key to correct code selection is determining the method of obtaining reformatted images. Typically, the technologist performs reformatting work on the acquisition scanner and the physician either performs reformatting on the independent workstation or supervises a technologist who is specially trained to do so.

    Concurrent physician supervision

    Both codes 76376 and 76377 require concurrent physician supervision of image postprocessing 3D manipulation of volumetric data set and image rendering.

    So what constitutes concurrent physician supervision? For those providers paid under Medicare Physician Fee Schedule (MPFS), the MPFS physician supervision indicators provide clarification (see the related chart on p. 8 of the PDF of this issue).

    Levels of supervision defined in 42 CFR 410.32 are as follows:

  • General supervision means a procedure guided by the physician's overall direction and control, although the physician need not attend the procedure. Under general supervision, physicians retain the continuing responsibility for the training of the nonphysician personnel who perform the diagnostic procedure and maintenance of the necessary equipment and supplies.
  • Personal supervision means a physician must be in the room during the procedure.

    Note: These supervision levels do not apply to hospitals.

    Report codes 76376 and 76377 in addition to the base imaging procedure. However, CPT specifically states that you should not report 76376 and 76377 in conjunction with the following codes: 70496, 70498, 70544-70549, 71275, 71555, 72159, 72191, 72198, 73206, 73225, 73706, 73725, 74175, 74185, 75635, 78814-78816, 0066T, 0067T. Further, do not report these codes in conjunction with nuclear medicine codes or the Category III cardiac CT and CTA codes.

    The CPT Assistant plans to publish this in a future article.

    Documentation required for billing

    The American College of Radiology (ACR) Practice Guideline for Communication recommends that the radiology report include "a description of the studies and/or procedures performed."

    If 3D images are produced, whether on the acquisition scanner or an independent workstation, clearly document the rendering and interpretation of the images in the report, the ACR says.

    As for whether a test order is required to code and bill for these procedures, a recent issue of the ACR Radiology Coding Source provided the following clarification:

    "In the past, the ACR maintained that an order for 2D and 3D reconstruction imaging was not necessary as this was covered under the ordering of diagnostic tests rule test design exception. However, based on the exponential rise in the use of 76375 and in the number of practice investigations evolving out of overutilization (i.e., routine use), the ACR strongly encourages radiology practices to obtain an order from the referring physician in the nonhospital setting. In the hospital setting, radiologists may generate their own order, but are strongly encouraged to justify medical necessity for the use of 3D rendering in a separate dictation.

    The 3D rendering should be done at the request of or in consultation with the referring physician when there is medical necessity. Reserve codes for additional imaging needed for surgical planning or for complete depiction of an abnormality from the two-dimensional study.

    Practices that routinely provide 3D rendering may prompt an investigation by the Office of Inspector General.

    Insider source

    Stacie L. Buck, RHIA, LHRM, Southeast Radiology Management Corp., 512 St. Lucie Crescent Stuart, FL 34994; stacie@southeastrad.com.

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