How To Use CPT Code 70486

CPT 70486 is a diagnostic imaging code for computed tomography (CT) scans of the maxillofacial area without contrast material. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 70486 procedures.

1. What is CPT 70486?

CPT 70486 is a diagnostic imaging code used for computed tomography (CT) scans of the maxillofacial area without the use of contrast material. This code is utilized when a healthcare provider needs to examine the maxillofacial area, such as the upper jaw or facial structures, for various medical conditions or abnormalities.

2. 70486 CPT code description

The official description of CPT code 70486 is: “Computed tomography, maxillofacial area; without contrast material.”

3. Procedure

1. The patient is positioned on the CT scanner table.
2. The table slides into the CT scanner, positioning the patient’s maxillofacial area within the scanner’s field of view.
3. The patient remains still while the CT scanner takes X-ray images of the target anatomy, such as the upper jaw and facial structures.
4. From these scans, a computer creates images called slices, which help the provider identify tumors, anatomic abnormalities, or foreign bodies.

4. Qualifying circumstances

Patients eligible to receive CPT code 70486 services are those who require a CT scan of the maxillofacial area without contrast material for diagnostic purposes. This may include patients with suspected tumors, anatomic abnormalities, or foreign bodies in the maxillofacial area. Additionally, patients with a history of allergic reactions to contrast material or those with contraindications for contrast administration may also be eligible for this code.

5. When to use CPT code 70486

It is appropriate to bill the 70486 CPT code when a healthcare provider performs a CT scan of the maxillofacial area without the use of contrast material for diagnostic purposes. This code should be used when the provider needs to examine the maxillofacial area for various medical conditions or abnormalities, and the use of contrast material is not indicated or contraindicated.

6. Documentation requirements

To support a claim for CPT 70486, the following information should be documented:

• Medical necessity for the CT scan of the maxillofacial area without contrast material
• Indications for the procedure, such as suspected tumors, anatomic abnormalities, or foreign bodies
• Contraindications or reasons for not using contrast material, if applicable
• Details of the procedure, including patient positioning, image acquisition, and image interpretation
• Findings and conclusions from the CT scan

7. Billing guidelines

When billing for CPT code 70486, it is essential to follow payer-specific guidelines and rules. Providers who supply contrast may also separately report the contrast using a 99070 supply code or a HCPCS Level II code, depending on the payer’s policies. If reporting only the physician’s interpretation for the radiology service, append professional component modifier 26 to the radiology code. If reporting only the technical component for the radiology service, append modifier TC to the radiology code. Do not append a professional or technical modifier to the radiology code when reporting a global service in which one provider renders both the professional and technical components.

8. Historical information

CPT 70486 was added to the Current Procedural Terminology system on January 1, 1990. The code was changed on January 1, 2003, from “Computerized axial tomography, maxillofacial area; without contrast material” to its current description.

9. Similar codes to CPT 70486

Five similar codes to CPT 70486 and how they differentiate are:

1. CPT 70487: This code is for CT scans of the maxillofacial area with contrast material.
2. CPT 70488: This code is for CT scans of the maxillofacial area without contrast material, followed by contrast material and further sections.
3. CPT 70450: This code is for CT scans of the head or brain without contrast material.
4. CPT 70460: This code is for CT scans of the head or brain with contrast material.
5. CPT 70470: This code is for CT scans of the head or brain without contrast material, followed by contrast material and further sections.

10. Examples

Here are 10 detailed examples of CPT code 70486 procedures:

1. A patient with a history of sinus infections undergoes a CT scan of the maxillofacial area without contrast to evaluate sinus anatomy and possible obstruction.
2. A patient with facial pain and swelling undergoes a CT scan of the maxillofacial area without contrast to assess for possible abscess or infection.
3. A patient with a history of facial trauma undergoes a CT scan of the maxillofacial area without contrast to evaluate bone fractures and soft tissue injuries.
4. A patient with suspected maxillary sinus cancer undergoes a CT scan of the maxillofacial area without contrast to assess tumor size and location.
5. A patient with a history of foreign body ingestion undergoes a CT scan of the maxillofacial area without contrast to locate the foreign body.
6. A patient with a known allergy to contrast material undergoes a CT scan of the maxillofacial area without contrast to evaluate facial structures for possible abnormalities.
7. A patient with suspected temporomandibular joint (TMJ) disorder undergoes a CT scan of the maxillofacial area without contrast to assess joint anatomy and function.
8. A patient with a history of chronic headaches undergoes a CT scan of the maxillofacial area without contrast to evaluate possible sinus-related causes.
9. A patient with suspected orbital cellulitis undergoes a CT scan of the maxillofacial area without contrast to assess the extent of infection and possible complications.
10. A patient with a history of dental implant complications undergoes a CT scan of the maxillofacial area without contrast to evaluate implant placement and surrounding bone structure.