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To 3D or Not to 3D

By Melody Mulaik

While the 3D procedures codes 76376 and 76377 have existed for a number of years, questions still arise as to their appropriate application. The answer depends upon the modality, whether a code exists that includes 3D by definition and/or if the documentation and medical necessity requirements are met. Let’s address the question as to whether or not the 3D codes may be assigned in addition to the base study by modality.

Regular diagnostic studies: No. According to CPT Assistant (September 2019) 76376 is only applicable to advanced 3D rendering performed for the imaging modalities included in the code descriptors (CT, MRI, ultrasound or other tomographic modality). The use of the 3D codes necessitates 3D post-processing for advanced visualization and volumetric assessment derived from 2D tomographic images.

Ultrasound: Yes. Code 76376 is used when 3D rendering is performed on the ultrasound console, and 76377 is used when 3D rendering is performed on an independent workstation (e.g., PACS workstation). The 3D rendering code should be reported in addition to the code for the ultrasound exam. The most frequently encountered studies are OB ultrasounds and breast ultrasound utilizing Automated Breast Ultrasound System (ABUS) technology.

Mammography: No. Tomosynthesis is sometimes incorrectly referred to as 3D but it is a different technology. There are codes for breast tomosynethesis that should be utilized when performed so no 3D should be assigned for mammography services.

CT/CTA: Yes, for regular CT scans. CTA requires and includes 3D angiographic rendering so it would not be appropriate to assign a 3D code in conjunction with a CTA exam. Two-dimensional reconstruction, such as reformatting an axial scan into the coronal plane, is included in the CT scan code and is not separately reportable. However, three-dimensional (3D) rendering can be coded in addition to CT scans and certain other procedures.

MR/MRA: Yes. Codes 76376 and 76377 can be used in conjunction with MRI codes when 3D images are created unless 3D is already included in the code definition (e.g., breast MRI). 3D rendering is included in MRA and should not be reported together with the MRA codes.

Nuclear Medicine (including PET): No. According to the CPT® manual, 3D rendering should not be reported in conjunction with any nuclear medicine study, including PET. The reason is that nuclear medicine procedures already have postprocessing work included in the value of the code.

If you are allowed to assign a code for 3D post processing services, the code assignment depends upon whether the 3D postprocessing was performed on the scanner workstation (76376) or an independent workstation (76377). If the 3D rendering is performed on the same workstation that processes 2D images, then code 76376 should be assigned. Code 76377 should not be assigned unless the radiology report indicates an independent workstation was used for the postprocessing.

In addition to the term “3D,” other terms such a maximum intensity projections (MIPS), shaded surface rendering and volume rendering may also be used to describe 3D postprocessing. Multiplanar reconstruction (MPR) does not qualify as 3D. (See Clinical Examples in Radiology, Fall 2013).

Finally, don’t forget that 3D rendering codes require concurrent physician supervision of image postprocessing 3D manipulation of volumetric data set and image rendering.

Melody W. Mulaik, MSHS, CRA, RCC, RCC-IR, CPC, COC, FAHRA, is the president of Revenue Cycle and Coding Strategies Inc.

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