AAPC - American Academy of Professional Coders Radiology Section Guidelines Questions and Answers — Questions and Answers
Question 1: A radiologist, who is an independent contractor, interprets a chest X-ray that was performed at a hospital. The hospital owns the equipment and its employee performed the technical portion of the service. How should the radiologist report their service?
- Report the CPT code with modifier TC
- Report the CPT code with modifier 26 (Correct answer)
- Report the CPT code without a modifier
- Report the CPT code with modifier 52
Correct answer: Report the CPT code with modifier 26
Modifier 26 is used to indicate that only the professional component of a procedure was performed. In this scenario, the radiologist only provided the interpretation and report (the professional service), while the hospital provided the equipment, supplies, and technician (the technical component). Therefore, appending modifier 26 to the appropriate CPT code is correct.
Question 2: A patient undergoes a CT scan of the abdomen without contrast, followed by an additional scan of the same area with IV contrast during the same session. Which of the following best describes how this should be coded?
- Code the CT abdomen without contrast, and separately code the CT abdomen with contrast.
- Code only the CT abdomen with contrast, as it is the more comprehensive service.
- Use a single CPT code that describes a CT scan performed 'without contrast, followed by with contrast'. (Correct answer)
- Bill for the contrast material using a HCPCS code and the CT without contrast CPT code.
Correct answer: Use a single CPT code that describes a CT scan performed 'without contrast, followed by with contrast'.
CPT provides specific codes for radiological studies performed without contrast, with contrast, and 'without, followed by with contrast'. When both types of scans are performed on the same anatomical area during the same encounter, the single combination code that describes both services should be used. It is incorrect to bill for the two separate scans.
Question 3: In the CPT manual, what does the designation '(separate procedure)' following a code description imply?
- The procedure must always be billed with modifier 59.
- The procedure was the only one performed during the patient encounter.
- The procedure is normally part of a more extensive service and should not be billed separately if a related, larger procedure is performed. (Correct answer)
- The procedure can only be reported by a different physician on the same day.
Correct answer: The procedure is normally part of a more extensive service and should not be billed separately if a related, larger procedure is performed.
The '(separate procedure)' designation means the procedure is often an integral component of a larger service. It should not be reported separately when performed along with another procedure in an anatomically related region. It can be reported if it is the only procedure performed or if it is distinct and unrelated to other procedures performed during the same encounter.
Question 4: An interventional radiologist performs a diagnostic renal angiogram. They access the arterial system via the right common femoral artery, advance the catheter into the aorta, and then selectively guide it into the left renal artery for imaging. How is the catheter placement best described?
- Non-selective catheter placement
- Second-order selective catheter placement
- Global catheter placement
- Selective catheter placement (Correct answer)
Correct answer: Selective catheter placement
Non-selective catheter placement occurs when the catheter remains in the initial vessel accessed or is placed only into the aorta. Selective catheter placement occurs when the catheter is advanced beyond the initial vessel or aorta into a branch vessel. Since the catheter was moved from the aorta into the renal artery, it is a selective placement.
Question 5: A physician in a freestanding imaging center must provide which level of supervision for a CT scan of the lumbar spine with contrast?
- General supervision
- Personal supervision
- Direct supervision (Correct answer)
- No supervision required
Correct answer: Direct supervision
According to CMS guidelines, certain complex diagnostic tests, especially those involving contrast material, require 'direct supervision'. Direct supervision means the physician must be present in the office suite and immediately available to provide assistance, though they do not need to be in the room where the procedure is performed.
Question 6: A patient has a complete abdominal ultrasound (76700) and a complete retroperitoneal ultrasound (76770) performed during the same session by the same physician. Which modifier is most appropriately appended to the second procedure code?
- Modifier 26 (Professional Component)
- Modifier 76 (Repeat Procedure by Same Physician)
- Modifier 59 (Distinct Procedural Service) (Correct answer)
- Modifier 50 (Bilateral Procedure)
Correct answer: Modifier 59 (Distinct Procedural Service)
Modifier 59 is used to identify a procedure or service that is distinct or independent from other services performed on the same day. Since the complete abdominal and complete retroperitoneal ultrasounds are different anatomical areas and are not bundled by NCCI edits, Modifier 59 should be used on the code for the second procedure to indicate it was a separate and distinct service from the first.
AAPC - American Academy of Professional Coders Radiology Section Guidelines Questions and Answers
A radiologist, who is an independent contractor, interprets a chest X-ray that was performed at a hospital.
The hospital owns the equipment and its employee performed the technical portion of the service.
How should the radiologist report their service?