CPT 76376, 76377 - 3D Interpretation and Reporting of Imaging Studies - covered DX


Indications and Limitations of Coverage and/or Medical Necessity
Indications:
Notice: It is not appropriate to bill Medicare for services that are not covered (as described by this entire LCD) as if they are covered.
The advent of multi-slice imaging and enhanced imaging techniques has allowed for the generation of 3-D images. Applications of this technology include visualization of central nervous system vasculature, coronary artery imaging, enhanced imaging of the thorax to include embolic disease, inflammatory and neoplastic lesions and multiple others. Medicare expects that no more than 20 percent of the total Computerized Tomography (CT) and Magnetic Resonance (MR) imaging of any practice be submitted with 3-D rendering or interpretation, with or without image post-processing. For non-hospital based outpatient services, Medicare expects the referring physician to generate a written request indicating the clinical need for the additional 3-D 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 3-D 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. Ordering physician requirements for services to hospital inpatients are found at 42 CFR 482.26 (b) (4). Ordering physician requirements for services to hospital outpatients are found at 42 CFR 410.32 (a), 42 CFR 410.32(d)(2) through (4), and 42 CFR 410.32(e).
Limitations

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 CT scan (two-dimensional) without reconstruction.
Notice: This LCD imposes diagnosis limitations that support diagnosis to procedure code automated denials. However, services performed for any given diagnosis must meet all of the indications and limitations stated in this policy, the general requirements for medical necessity as stated in CMS payment policy manuals, any and all existing CMS national coverage determinations, and all Medicare payment rules.
As published in CMS IOM 100-08, Section 13.5.1, to be covered under Medicare, a service shall be reasonable and necessary. When appropriate, contractors shall describe the circumstances under which the proposed LCD for the service is considered reasonable and necessary under Section 1862(a)(1)(A). Contractors shall consider a service to be reasonable and necessary if the contractor determines that the service is:

  • Safe and effective.
  • Not experimental or investigational (exception: routine costs of qualifying clinical trial services with dates of service on or after September 19, 2000, which meet the requirements of the clinical trials NCD are considered reasonable and necessary).
  • Appropriate, including the duration and frequency that is considered appropriate for the service, in terms of whether it is:
    • Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient’s condition or to improve the function of a malformed body member.
    • Furnished in a setting appropriate to the patient’s medical needs and condition.
    • Ordered and furnished by qualified personnel.
    • One that meets, but does not exceed, the patient’s medical need.
    • At least as beneficial as an existing and available medically appropriate alternative.
    •  
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
12X, 13X, 21X, 22X, 23X, 71X, 75X, 83X, 85X
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
Note: TrailBlazer has identified the Bill Type and Revenue Codes applicable for use with the CPT/HCPCS codes included in this LCD. Providers are reminded that not all CPT/HCPCS codes listed can be billed with all Bill Type and/or Revenue Codes listed. CPT/HCPCS codes are required to be billed with specific Bill Type and Revenue Codes. Providers are encouraged to refer to the CMS Internet-Only Manual Publication 100-04, Claims Processing Manual, for further guidance.
032X, 035X, 040X, 061X, 092X

CPT/HCPCS Codes
Note:
Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book. The American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) require the use of shortCPT descriptors in policies published on the Web.
76376©
3d render w/o postprocess
76377©
3d rendering w/postprocess
ICD-9-CM Codes That Support Medical Necessity
Note: One of the following diagnosis codes must accompany a primary diagnosis code (see “Coding Guidelines” in related article). The use of these diagnosis codes implies the medical necessity of the 3-D rendering and interpretation is documented in the medical record with a written request for the study from the referring physician, and is available upon request.
The CPT/HCPCS codes included in this LCD will be subjected to “procedure to diagnosis” editing. 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.
Medicare is establishing the following limited coverage for CPT/HCPCS codes 76376 and 76377:
Covered secondary diagnoses:
793.0
Non-specific (abnormal) finding on radiological and other examinations of body structure – skull and head
793.1
Non-specific (abnormal) findings on radiological and other examinations of body structure – lung field
793.2
Non-specific (abnormal) findings on radiological and other examinations of body structure – other intrathoracic organs
793.4
Non-specific (abnormal) findings on radiological and other examinations of body structure – gastrointestinal tract
793.5
Non-specific (abnormal) findings on radiological and other examinations of body structure – genitourinary organs
793.6
Non-specific (abnormal) findings on radiological and other examinations of body structure – abdominal area including retroperitoneum
793.7
Non-specific (abnormal) findings on radiological and other examinations of body structure – musculoskeletal system
Note: Providers should continue to submit ICD-9-CM diagnosis codes without decimals on their claim forms and electronic claims.
Diagnoses That Support Medical Necessity
N/A
ICD-9-CM Codes That DO NOT Support Medical Necessity
N/A
Diagnoses That DO NOT Support Medical Necessity
All diagnoses not listed in the “ICD-9-CM Codes That Support Medical Necessity” section of this LCD.
Documentation Requirements
Documentation supporting the medical necessity should be legible, maintained in the patient’s medical record and made available to Medicare upon request.

Use of one of the secondary diagnosis codes in this LCD implies medical necessity for 3-D rendering and interpretation. Documentation supporting medical necessity must be maintained in the medical record along with the written request for the study from the referring physician.

Documentation of the time of the study, the specific need for the study, and the summary of the findings that were urgently transmitted to the practitioner named as the referring physician must be maintained by the radiologist and made available to Medicare upon request.
Appendices
N/A
Utilization Guidelines
N/A
Sources of Information and Basis for Decision
J4 (CO, NM, OK, TX) MAC Consolidation
TrailBlazer adopted, unchanged, the TrailBlazer LCD, “3-D Interpretation & Reporting of Imaging Studies,” for the Jurisdiction 4 (J4) MAC transition.
Full disclosure of the sources of information is found with original contractor LCD.
Other Contractor Local Coverage Determinations
“3D Interpretation and Reporting of Imaging Studies,” TrailBlazer LCD, (00400) L23930, (00900) L24943.























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