SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: 3D Interpretation and Reporting of Imaging Studies

A56526

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
Superseded
To see the currently-in-effect version of this document, go to the section.

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Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A56526
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: 3D Interpretation and Reporting of Imaging Studies
Article Type
Billing and Coding
Original Effective Date
05/16/2019
Revision Effective Date
11/14/2019
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Please refer to the Local Coverage Determination (LCD) L35408, 3D Interpretation and Reporting of Imaging Studies.

Article Guidance

Article Text

Refer to Local Coverage Determination (LCD) L35408, 3D Interpretation and Reporting of Imaging Studies, for reasonable and necessary requirements.

The Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) code(s) may be subject to National Correct Coding Initiative (NCCI) edits. This information does not take precedence over NCCI edits. Please refer to NCCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.

Coding Guidelines

Medicare expects there will be a primary diagnosis code(s) that is representative of the patient's medical condition, which supports the need for the base imaging procedure. Use the secondary diagnosis that most closely represents the body area that is to be 3-D imaged (implies medical necessity for 3-D rendering and interpretation).

All primary diagnosis codes must be related to the primary procedural code when rendered for the 3D reconstruction. The use of these diagnosis codes implies the medical necessity of the 3D rendering and interpretation, as outlined in the related LCD, L35408, is documented in the medical record. A written request for the study from the referring physician must also be in the medical record and made available upon request when performed in freestanding and independent diagnostic testing facilities.

CPT codes 76376 and 76377 must be performed in conjunction with the base imaging procedure. Medicare would expect the base imaging procedure to be billed on the same claim as CPT code 76376 or 76377 the majority of the time.

CPT codes 76376 and 76377 are allowed only when billed in conjunction with another computed tomography, magnetic resonance imaging or other tomographic modality procedure codes.

CPT code 76376 can be reported when 3D rendering is performed by a radiologist or a specially-trained technologist at the acquisition scanner.

CPT code 76377 is reported when the 3D post-processing images are reconstructed on an independent workstation with concurrent physician supervision.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
999x Not Applicable
N/A

Revenue Codes

Code Description
99999 Not Applicable
N/A

CPT/HCPCS Codes

Group 1

(2 Codes)
Group 1 Paragraph

Note: Providers are reminded to refer to the long descriptors of the CPT code in their CPT books.

Group 1 Codes
Code Description
76376 3d render w/intrp postproces
76377 3d render w/intrp postproces
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CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

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N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(13 Codes)
Group 1 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

Note: The following lists include only those secondary diagnoses for which the identified CPT/HCPCS procedures are covered.

Note: If a covered secondary diagnosis is not on the claim, the edit will automatically deny the service as not medically necessary.

Medicare is establishing the following limited coverage for CPT/HCPCS codes 76376 and 76377:

Group 1 Codes
Code Description
R90.82 White matter disease, unspecified
R91.8 Other nonspecific abnormal finding of lung field
R93.0 Abnormal findings on diagnostic imaging of skull and head, not elsewhere classified
R93.1 Abnormal findings on diagnostic imaging of heart and coronary circulation
R93.3 Abnormal findings on diagnostic imaging of other parts of digestive tract
R93.41 Abnormal radiologic findings on diagnostic imaging of renal pelvis, ureter, or bladder
R93.421 Abnormal radiologic findings on diagnostic imaging of right kidney
R93.422 Abnormal radiologic findings on diagnostic imaging of left kidney
R93.49 Abnormal radiologic findings on diagnostic imaging of other urinary organs
R93.5 Abnormal findings on diagnostic imaging of other abdominal regions, including retroperitoneum
R93.6 Abnormal findings on diagnostic imaging of limbs
R93.7 Abnormal findings on diagnostic imaging of other parts of musculoskeletal system
R93.89 Abnormal findings on diagnostic imaging of other specified body structures

Group 2

(8 Codes)
Group 2 Paragraph

Covered primary diagnosis for deep brain stem lead placement only (reporting one of the above secondary diagnosis is not required).

Group 2 Codes
Code Description
G20 Parkinson's disease
G21.4 Vascular parkinsonism
G24.1 Genetic torsion dystonia
G24.3 Spasmodic torticollis
G24.9 Dystonia, unspecified
G25.0 Essential tremor
G25.1 Drug-induced tremor
G25.2 Other specified forms of tremor
N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

All those not listed under the “ICD-10 Codes that Support Medical Necessity” section of this article.

Group 1 Codes

N/A

N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
999x Not Applicable
N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description
99999 Not Applicable
N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
11/14/2019 R2

Corrected typographical error in the "ICD-10 Codes that DO NOT Support Medical Necessity" section of the Article.

10/31/2019 R1

Consistent with CMS Change Request 10901, all coding information from the related LCD has been placed into this article. Due to system changes, the order of the Coding Section has been revised and new sections for CPT/HCPCS Modifiers and Other Coding Information have been added.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
09/28/2023 11/14/2019 - 09/28/2023 Retired View
11/08/2019 11/14/2019 - N/A Superseded You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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