Hi 286madisondental!

Sorry for the confusion. Perhaps these radiology billing guidelines can offer a better explanation :)

http://www.medsolutions.com/documents/guidelines/guideline_downloads/PREFACE%20to%20the%20IMAGING%20GUIDELINES.pdf

In the above link, it is stated:
If a diagnostic scan is performed and interpreted by a radiologist, the appropriate
diagnostic CT code (e.g., CPT® 70486) should be used.
It is not appropriate to report both CPT®70486 and CPT® 77011 for the same CT stereotactic localization imaging session.
3D Rendering (CPT® 76376 or CPT® 76377) should not be reported in conjunction
with CPT® 77011 (or CPT® 70486 if used). The procedure inherently generates a 3D dataset.

CPT® 76376 and CPT® 76377:
Both of these codes share the following text in their definitions: “3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound or other tomographic modality.”
Both codes require concurrent supervision of the image post-processing 3D manipulation of the volumetric data set and image rendering.
These two codes differ in the need for and use of an independent workstation for post-processing.
CPT® 76376 reports procedures not requiring image post-processing on an independent workstation.
CPT® 76377 reports procedures that require image post-processing on an independentworkstation.
These 3D rendering codes should notbe used for 2D reformatting.
Two-dimensional reconstruction (e.g. reformatting an axial scan into the coronal plane) is now included in all cross-sectional imaging base codes and is not separately reimbursable.
Some payers do not reimburse separately for CPT® 76376 or CPT® 76377.

Hi 286madisondental!

4) code 76376 - for ct only.
Taking CT and reading together?
On the seminar we were told that we can use this code 76376 just for reading, is it correct?

The code 70486 is for taking the CT and the read together. And yes, 76376 is for the 3D rendering and interpretation under supervision, so can be used for rendering & interp only.

5) Can we use code 41823 for D4260 - osseous surgery ?
Will you suggest to use tooth# or area for this code? (in dental we use area)

Yes you certainly can! If the insurer you file it to is one that refuses to process "D" codes, then you can use 41899 instead. For this one, i would suggest using the JO qualifier for areas of the oral cavity:

The following are the codes for areas of the oral cavity, reported with the JO qualifier:
00 - Entire oral cavity
01 - Maxillary arch
02 - Mandibular arch
10 - Upper right quadrant
20 - Upper left quadrant
30 - Lower left quadrant
40 - Lower right quadrant

Hope this helps, have a great day!

Hi 286madisondental!

Glad you enjoyed the CT crosscoding course :)

1) Please provide me more information about teeth or area numbers for Bone grafting with implants.
For example, D6010#18,#19 and d7953 #18,#19.
Do I add tooth # - JP18 19 or area JO30 ?

For bone grafting and implants, i prefer to use the tooth numbers using the JP qualifier. In the red shaded lines of box 24 on the claim form, you will enter it as:
JP18 19
(basically, JP, then the first tooth number with no spaces, then spaces in between any subsequent tooth number. No "#" signs or anything like that). You can see the full instructions for this in the NUCC's claim form manual, these instructions start on page 46. Here is the link to it: http://www.nucc.org/images/stories/PDF/1500_claim_form_instruction_manual_2012_02-v4.pdf

2) For D4260 - Osseous Surgery
Is it better to use D41899 or D41825
Which one is paid more often?
So, for D4260, the CPT crosscode is actually "41899" (no "D" on the front end of it).
Same with 41825, no "D" in front of it.
41825 stands for: Excision of lesion or tumor (except listed above), dentoalveolar structures; without repair
41899 stands for: Unlisted procedure, dentoalveolar structures

So, whichever description between 41825 and 41899 best describes the procedure you are doing will be the one you want to use. As far as which one gets paid more often? That completely depends on the documentation submitted with the claim/pre-auth and the patient's policy :)


3) For Xrays reading, which code is more appropriate ?
Reading Pano - 70355,26
Reading CT - 70486,26
Yes the 26 modifier stands for "professional component" so would be appropriate to describe the "read" only of each of those. When billed with no modifier, each code contains both the professional and the technical component. The "TC" modifier stands for the technical component only.


When is it appropriate to use code 76376? What is that code for? rendering 3d? Cone beam 3d or CT ?
76376 stands for: 3D RENDERING WITH INTERPRETATION AND REPORTING OF COMPUTED TOMOGRAPHY, MAGNETIC RESONANCE IMAGING, ULTRASOUND, OR OTHER TOMOGRAPHIC MODALITY WITH IMAGE POSTPROCESSING UNDER CONCURRENT SUPERVISION; NOT REQUIRING IMAGE POSTPROCESSING ON AN INDEPENDENT WORKSTATION

...so should only be used for CT scans. As for a CBCT, different insurers currently are preferring different codes. Many have stated 70486 is not an appropriate code for CBCT. Some policies list the following code for CBCT:
76497 - Unlisted computed tomography procedure (eg, diagnostic, interventional)

For example, here is a link to a policy from BCBS of RI that lists 76497 as the code to use for CBCT:
https://bcbsri.com/sites/default/files/polices/Cone%20Beam%20Computed%20Tomography.pdf

While some other insurers list the "D" codes for CBCT in their medical policies.

For example, here are the “D” codes from HealthPartner’s medical policy for “Cone-beam computed tomography (CT) scan for medically-related dental services”

D0363 - Cone-Beam 3D multi image reconstruction
D0364 - Cone beam CT capture and interpretation with limited field of view - less than one whole jaw
D0365 - Cone beam CT capture and interpretation with field of view of one full dental arc - mandible
D0366 - Cone beam CT capture and interpretation with field of view of one full dental arch
- maxilla, with or without cranium
D0367 - Cone beam CT capture with interpretation with field of view of both jaws, with or without cranium
D0368 - Cone beam CT capture and interpretation for TMJ series including two or more exposures
D0380 - Cone beam CT image capture with limited field of view - less than one whole jaw
D0381 - Cone beam CT image capture with field of view of one full dental arch - mandible
D0382 - Cone beam CT image capture with field of view of one full dental arch - maxilla, with or without cranium
D0383 - Cone beam CT image capture with field of view of both jaws, with or without cranium
D0384 - Cone beam CT image capture for TMJ series including two or more exposures

Here is a link to the full policy:
https://www.healthpartners.com/public/coverage-criteria/cone-beam-scan.htm

Hope this helps, have a great day!