How do you code for additional volume quantification following magnetic resonance imaging (MRI)? Is CPT code 76377, 3D rendering with interpretation and reporting of CT, MRI, US or other tomographic modality with image post-processing under concurrent supervision; requiring imaging post-processing on an independent workstation, the appropriate code to use?
It is appropriate to report CPT code 76377 if it meets the requirements for CPT 76377, 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image post-processing under concurrent supervision; requiring image post-processing on an independent workstation.
However, it is not appropriate to report CPT code 76377 if MRI data is loaded onto a vendor's computer system at an off-site location for post-processing and a summary report is generated that is then used by the physician treating the patient as part of an evaluation and management service. In this scenario, this additional volume quantification following magnetic resonance imaging (MRI) does not involve separate identifiable physician work and is included in the base MRI code. The 3D rendering code 76377 is not separately reportable because there is no concurrent physician supervision.
How do we code for a single planar imaging session alone or planar with SPECT imaging using 99mTc PYP looking for cardiac amyloidosis? Since the procedure is similar to infarct avid CPT 78469, should we use that CPT code?
The ACR and Society of Nuclear Medicine and Molecular Imaging do not recommend reporting CPT 78469, Myocardial imaging, infarct avid, planar; tomographic SPECT with or without quantification, to describe a single planar imaging session alone or planar with SPECT imaging using 99mTc PYP looking for cardiac amyloidosis. CPT code 78469 was established for a different purpose, and cardiac amyloidosis is not an infarct procedure. As per CPT instructions, “Select the name of the procedure or service that accurately identifies the service performed. Do not select a CPT code that merely approximates the service provided.”
After reviewing the CPT options, the ACR and SNMMI recommend CPT 78800, Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent(s); limited area, for a single planar imaging session alone (without a SPECT study), and CPT 78803, Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent(s); tomographic (SPECT), for planar imaging with SPECT, as these CPT codes accurately describe the services. When reporting CPT 78803, limited or multiple planar imaging would be included with the SPECT, therefore, this CPT code reflects the service performed. Report HCPCS Level II code A9538, Technetium Tc-99M pyrophosphate, diagnostic, per study dose, up to 25 millicuries, to describe the radiopharmaceutical used.