(2023) CPT Code 70450 | Description, Guidelines, Reimbursement, Modifiers & Examples
CPT code 70450 performed a non-contrast computed tomography (CT) scan of the head or brain. He will discover a brain or intracranial abnormality during this procedure. An X-ray and computer-generated cross-sectional image of the brain is created using computerized axial tomography (CAT), a non-invasive neurodiagnostic approach.
Summary
A tiny X-ray beam may be used to scan the skull in layers to determine the transmission of X-ray photons. Graphic representations of tomographic “slices” are created using the X-ray photon data obtained. Typical brain structures and various intracranial disorders may be seen.”
Scanners may be used to do a diagnostic head examination using computed tomography (CT) if they are FDA-approved, adequate for a specific disease, reasonable, and necessary for the individual patient.
Given the patient’s symptoms and a preliminary diagnosis, it is required to determine whether or not a CCT scan is medically appropriate.
There may be a significant time between the birth of technology and its recognition as a chargeable business. Furthermore, radiology is ever-evolving, with new imaging techniques making their way into clinical practice over time.
Recent imaging modalities, such as CT colonography, functional MRI, and CT perfusion imaging, have been issued CPT (Current Procedural Terminology) codes.
However, dual-energy CT is an example of a therapeutically valuable diagnostic for which no CPT Current Procedural Terminology code is currently not defined.
Description Of The CPT Code 70450
CPT Code 70450 is used to represent radiology and diagnostic radiology, respectively. General recommendations state that a CT scan of the head or brain is appropriate for this code. We’ve compiled the expenses of this therapy using publicly available data, which identifies all of the doctors that submitted claims to Medicare using this code.
The official description of CPT code 70450 is: “Computed tomography, head or brain; without contrast material.”
Depending on the specific situation, you might be charged more or less for this CPT code. For example, computerized tomography (CT scanning) uses the attenuation of an X-ray beam by an object in its path to produce cross-sectional images.
X-rays depart the body at varied angles, and photons are detected and recorded. Computers then slice the data into a cross-sectional view of the subject’s anatomy.
Various post-acquisition processing methods may be used for the signal data to get a multiplanar theory of the anatomy.
Procedure codes are used in radiology activities, including ordering, scheduling, billing, and interpreting images. However, radiology departments have long used process codes that are neither conventional nor systematic.
Even though these codes may be suitable for specific purposes, they do not facilitate interoperability. As radiology operations and clinical data exchange have become more sophisticated, the need for increased interoperability with standardized structured codes has risen.
For example, it is much simpler to track radiation dose using structured codes than without them. The authors examine how radiology departments and the broader healthcare system utilize imaging procedure codes. First, we’ll discuss organized coding systems and radiology procedure coding standards.
It thoroughly explains how to use the RadLexTM Playbook coding system and its structure. RadLex Playbook system compliance with the logical observation identifiers names and codes (LOINC) standard is being considered currently; Adopting uniform principles and the difficulties in mapping local regulations to standards principles are highlighted.
It is also suggested that billing codes be used as a bridge in the mapping process to help overcome these roadblocks. Different brain structures and a wide variety of intracranial disorders may be seen.
It is shown in the article that code mapping may be somewhat automated using the RadLex Playbook Web service application programming interface.
Billing Guidelines
There must be a charge for the international diagnostic service code if a test was performed and evaluated by a physician, a billing agency, or both. When a GDS code, such as CPT code 70450, is used to charge a diagnostic service, such as a chest x-ray, the location is based on the ZIP code associated with the testing facility (no modifier TC no modifier -26).
A physician or supplier organization must offer a diagnostic service’s TC and PC in the same MPFS payment zone. If this is not the case, the diagnostic service will not be able to be charged. The testing facility (or its billing agent) enters the address and ZIP code of the test’s location.
The CPT is a common standard for procedure codes (Current Procedural Terminology). However, since it was developed for billing purposes, it falls short in many situations.
The coding requirements for various operations varied a little, but a lot. For example, anatomic granularity or other differentiating characteristics stated in the codes may influence workflows. Consider, for example, MR imaging of the extremities.
Computed tomography (CT) images may be used for a diagnostic head examination provided they are FDA-approved, sufficient for a particular ailment, reasonable, and essential for the individual patient’s health care needs.
It is necessary to assess whether or not a CCT scan is medically necessary based on the patient’s symptoms and a preliminary diagnosis before proceeding with the procedure.
Furthermore, radiology is constantly expanding, with new imaging methods regularly finding their way into clinical practice as new technologies are developed. Therefore, anatomic granularity is not the only factor that affects the ordering and billing procedure.
When ordering radiology, many institutions provide specifics about the anatomy or region to be scanned during order input; (for example, “MRI shoulder without contrast”).
To bill for these tests under CPT Current Procedural Terminology, less specific codes (such as CPT Current Procedural Terminology 70450: “magnetic resonance [e.g., proton] imaging, any joint of the upper extremities, without contrast material[s]”) must be used. Other factors included such as clinical indications and examination complexity.
How To Use Modifiers With The 70450 CPT Code
Using CPT® modifier 26, the provider’s effort, associated overhead, and professional liability insurance costs are included in the professional component of a global service or process. When this modifier is used, a service or activity is said to have human involvement.
Diagnostic or laboratory data is typically read and interpreted using Modifier 26, often linked to procedure codes. The Modifier 26 standards should be followed to assess claims correctly. Non-contrast computed tomography (CT) scans of the brain are performed at this facility (CPT code 70450).
Local radiologists are sent the footage for evaluation. It was determined that the CT scan showed no symptoms of injury or damage. Therefore the radiologist called the hospital’s emergency department and instructed them to release him.
When the TC and PC of the diagnostic service are not provided by the same physician or another supplier organization, the interpreting physician must separately charge with modifier 26. Those instances in which the same physician or another provider entity gives both the TC and PC but does not offer a professional interpretation.
As indicated by modifier 26, physicians who interpret diagnostic tests are reimbursed separately from those who perform the technical component. Physicians who submit claim forms for payment must include their billing agency with their address and ZIP code.
If the professional interpretation occurs in an uncommon or unique venue, such as a hotel, it may be vital to know where the interpreter will be.
When modifier 99 (many modifiers) is specified in item 24d, include all appropriate modifiers. In addition, multiple line items with the modifier 99 should be listed: A-line item is represented by the number 1, and “mod” indicates any modifications applied to that line item.
Reimbursement
New coding schemes for E/M services have significantly contributed to the decrease in reimbursement. The improved E/M coding system allows doctors to code a visit depending on the time they spend with the patient or the level of medical decision-making during that time.
There is a risk that some specialties, including radiology, may significantly decrease Medicare payment if the MPFS Proposed Rule is adopted without changing the law’s budget neutrality clause.
An AUC/CDS rule denying reimbursement for medical procedures not performed as recommended will go in 2022.
Using data from our database, we investigated the likely impact on radiology offices’ most frequently performed procedures. According to the CMS, professional component reimbursement for CT thorax would decrease by 10% to 18%, reducing most designs by 11% to 13%. Our research also reveals that radiology will be cut by 11%.
Furthermore, radiology is ever-evolving, with new imaging techniques making their way into clinical practice over time. Recent imaging modalities, such as CT colonography, functional MRI, and CT perfusion imaging, have been issued CPT (Current Procedural Terminology) codes.
However, dual-energy CT is an example of a therapeutically valuable diagnostic for which no CPT Current Procedural Terminology code is currently not defined.
Billing Example
A patient with a head injury seeks treatment in a hospital’s Emergency Room (ER). The facility conducts a non-contrast CT scan of the head (CPT code 70450). The video is couriered to a well-known local radiologist for assessment.
The radiologist examines the CT film and finds no signs of injury or damage, so he contacts the hospital’s emergency room and tells them to discharge the patient.
