Basics of CPT code 76376 and 76377

Three dimensional images called 3D reconstruction or 3D rendering is a distinct diagnostic procedure that describes a separate procedure or process that can be applied to computed tomography (CT), magnetic resonance imaging (MRI), ultrasound or other tomographic modality. Having 3D capability available for diagnosis and surgical planning allows the interpreting physician to first get a summary view of the entire anatomy and then refer back to the original 2D data for
comparison and confirmation. 3D imaging takes multiple thin-section, usually axial, images and reconstructs them into a 3D image. CPT code 76376 and 76377 are used for coding 3D rendering with interpretation and reporting of CT, MRI and ultrasound.

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Code description of CPT code 76376 and 76377

• 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

CPT code 76376 and 76377 should be used along with few selected procedures only. They are always used as secondary CPT codes. But as per coding guidelines CPT code 76376 and 76377 should not be reported 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

These are mostly CTA exam codes which generally includes the 3D images.

A three-dimensional rendering of an ultrasound, MRI, CT scan, or other radiographic image is created for diagnostic purposes.  If the image requires postprocessing on an independent workstation (i.e., another computer), use 76377.  

(76376, 76377 require concurrent supervision of image postprocessing 3D manipulation of volumetric data set and image rendering)

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Bundled or NCCI edits Procedure codes with CPT code 76376 and 76377

Below are the list of CPT code that are having NCCI Edits with CPT code 76376 and 76377 which should be checked before assigning a bypass modifier 59 or X modifier.

ICD 10 covered diagnosis for CPT code 76376 and 76377

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 this LCD, 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. 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. 

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

R91.1 Solitary pulmonary nodule
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

R93.8  Abnormal findings on diagnostic imaging of other specified body structures

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Points to remember for coding CPT code 76376 and 76377

Q: Is it necessary to have a documentation of 3D images in medical reports for coding a CTA study?

Yes, it is necessary to have a documentation  of 3D images in the technique or exam of CTA study. The axial data set from which 3D images are created is insufficient for the reporting of a CTA study. When reformatted images are acquired and interpreted in addition to the CT axial images, the reformatted images are a part of the study and should be permanently archived. Just as it is required that a permanent hardcopy image be maintained for a plain film study, permanent CTA reformatted images should be permanently archived. 

Q. Can 2D ““images post processing,”  for exam can be used for coding CTA exam?

Two dimensional (2D) postprocessing does not constitute a computed tomographic angiography (CTA) study.When CT scanning is performed using contrast enhanced dynamic-timed imaging and 2D reformatted axial images are obtained or multiplanar reconstructions (MPR) (e.g., coronal, sagittal, or even an off-axis view) are done, this should be reported with a standard CT with contrast code that identifies the anatomic area studied. None of these 2D planar reconstructions qualify as “angiographic” reconstruction.

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

Do not report CPT 76376 or CPT 76377 in conjunction with any of the Nuclear Medicine Codes (78000-78999) or with the new Category III cardiac CT and CTA codes.

CPT 76376 and 76377 bundle into G0288 (Reconstruction, computed tomographic angiography of aorta for surgical planning for vascular surgery) and are not payable with G0288. G0288 only has a technical component with no professional component.

Coverage Indications, Limitations, and/or Medical Necessity

INDICATIONS:

The advent of multi-slice imaging and enhanced imaging techniques has allowed for the generation of 3D images. Applications of this technology include the visualization of inflammatory and neoplastic lesions, imaging of facial malformations, complex facial fracture/trauma, urographic, biliary and other indications. As the indications may be varied and the diagnoses for the base service vast, this LCD will outline codes to be added to the claim to attest that all LCD criteria have been met by the provider.

Also, 3D Imaging is used for Deep Brain Stimulation for lead placement. 

This LCD does not apply to 3D vascular imaging in conjunction with magnetic resonance angiography (MRA) or computed tomography angiography (CTA) and their respective CPT codes, whose coverage is otherwise specified via the NCD process.

LIMITATIONS:

1. In freestanding and independent diagnostic testing facilities, Medicare expects the referring physician to generate an appropriate written request indicating the clinical need for the additional 3D imaging, that a copy of that request be maintained by the interpreting physician and the interpreting physician’s report addresses those specific clinical issues. In the event that a 3D interpretation is deemed urgently needed by the radiologist and the referring physician is not immediately available, the radiologist must document the time of the study, the specific need for the study, and a summary of the findings that were urgently transmitted to the practitioner named as the referring physician on the radiology report.
2. CPT codes 76376 and 76377 may be considered medically unnecessary and denied if equivalent information obtained from the test has already been provided by another procedure (magnetic resonance imaging, ultrasound, angiography,etc.) or could be provided by a standard Computerized Tomography (CT) scan (two-dimensional) without reconstruction. 
3. Medicare expects that no more than 20 percent of the total CT and Magnetic Resonance (MR) imaging of any practice be submitted with 3D rendering or interpretation, with or without image post-processing. However, for cancer evaluation applications, such as staging/monitoring for pulmonary metastases, this threshold may be often exceeded. Therefore, if data suggests providers are billing at higher rates for other indications for 3D rendering, then Medical Review may do pre- or post-pay reviews to validate the use and medical necessity of the test. 
4. All imaging studies will be subject to the American College of Radiology (ACR) Guidelines for reporting. 
5. CPT code 76376 can be reported when 3D rendering is performed by a radiologist or a specially-trained technologist at the acquisition scanner. However, CPT code 76377 is reported when the 3D post-processing images are reconstructed on an independent workstation with concurrent physician supervision. In order to report CPT code 76377, the supervising physician must provide concurrent supervision.

In order to report the correct CPT code for the 3D analysis (76376 or 76377), it should be documented within the radiology report as to whether the 3D was performed on an independent workstation or on the acquisition scanner. Making an explicit statement within the radiology report will avoid ambiguity, and aid the coder in accurately coding for the 3D reconstruction. Some practices may separately document this in the patient’s electronic medical record, but not actually in the report. 

Imaging studies are complex with thousands of individual pictures. Beyond identifying a fracture in an emergency setting a discussion of treatment planning after the patient has left the department is common. 3D may be necessary to understand the anatomy for treatment planning. This discussion occurs after the acute event. Another vignette is an imaging study for stroke but later a seizure concern is identified subsequent to the emergency visit and 3D is applied to evaluate an anatomy of the hippocampus for a seizure focus.

References:

https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35408&ver=11&name=331*1&UpdatePeriod=696&bc=AQAAEAAAAAAAAA%3d%3d&