Don’t know what you are doing wrong when billing for a computed head or brain tomography? Follow our billing guidelines! CT scans are one of the most common diagnostic assessments in the U.S., accounting for around 5% of all new cancer diagnoses. These tests are, in fact, so popular that in 2023 alone, 93 million CT scans were performed in the country.
So, we can safely assume that you may have already performed this diagnostic test dozens of times, especially if you work in emergency care. But do you bill for this assessment routinely?
Let us be your guide if you are unfamiliar with the billing requirements for CPT code 70450. Read on to discover what this code covers, along with applicable modifiers.
CPT Code 70450 – Description
CPT code 70450 falls within the diagnostic radiology procedural codes for the head and neck. As you may have already guessed, this code refers to computed tomography, most commonly known as a CT scan.
Radiologists and professional billers use this code to bill for a brain or head CT scan without contrast. So what is this contrast? It is basically an iodine-based solution that healthcare providers inject into a vein to visualize certain structures or tissues.
In short, CPT code 70450 only covers a basic CT scan relying on X-ray technology. The primary purpose of this non-invasive service? To diagnose and monitor various conditions affecting a patient’s brain, such as injuries, tumors, and strokes.
Scenarios Where CPT Code 70450 is Applicable
Don’t need a contrast to visualize certain head or brain areas on a CT scan? We understand! However, you may need practical examples to visualize the correct application of CPT code 70450. Therefore, let’s look at the following scenarios:
Evaluating the Extent of Brain Damage After an Accident
Did you know that out of 100,000 individuals, 10 to 14 people in the U.S. experience subarachnoid hemorrhage every year? This uncommon type of stroke mainly occurs due to head trauma.
So, for the first example of CPT code 70450, suppose a 24-year-old woman is involved in a car accident. She is brought to the nearest emergency room due to her head injuries. The emergency physician evaluates her condition, checking her breathing, level of consciousness, and pupillary reflex.
Suspecting a subarachnoid hemorrhage, he quickly calls for a technician to perform a CT scan. The technician performs the test without the use of contrast. Hence, he bills for this service using 70450.
Identifying Intracranial Brain Hemorrhage
Brain hemorrhage (intracranial hemorrhage) is more common among adults over 65 years of age, especially those who use substances or have hypertension. Therefore, for the second scenario, envision a 67-year-old man who experiences a sudden headache. The headache is so severe that he loses consciousness.
His wife brings him to the nearest emergency department and relays relevant details. After evaluating the patient and learning about his hypertension history, the physician suspects an intracranial hemorrhage.
Therefore, he orders a brain CT scan without contrast to confirm his suspicion. A lab technician performs the test and uses CPT code 70450 to bill for it.
Detecting a Brain Tumor in a Pediatric Patient
We already know that the chances of brain tumors increase with age. But did you know that these types of tumors are also quite prevalent among children? In fact, they are the second most common type of cancer in children, affecting nearly 4,000 kids annually.
The first warning sign of a brain tumor? Persistent headache! So, for the final scenario of CPT code 70450, consider a 7-year-old with behavioral changes. He is constantly tired and exhibits lower energy. The parents initially ignore his symptoms. However, they bring him to the emergency department after he has a seizure at school.
The healthcare provider inquires about the child’s conditions, notes his symptoms, and conducts a detailed physical examination. He then performs a CT scan without contrast to find the source of the problem. His billing team later uses code 70450 to report the procedure.
Applicable Modifiers for CPT Code 70450
For conveying additional information, you can apply the following modifiers to CPT code 70450:
Modifier TC
Did your facility only perform a non-contrast CT scan without interpretation? In this case, use modifier TC with CPT code 70450 to only bill for the technical component.
Modifier 26
Was the test interpreted by another professional, for example, a local radiologist? In this scenario, the radiologist should report his professional role by appending modifier 26 with CPT code 70450.
Modifier 59
Was the non-contrast CT scan distinct from other services you performed on the same date? Apply modifier 59 to CPT code 70450, or better yet, one of the X{EPSU} modifiers.
Modifier 76
Did you repeat the CT scan without contrast on the same day due to medical necessity? Use modifier 76 with CPT code 70450.
CPT Code 70450 – Billing & Reimbursement Guidelines
So, how do you correctly bill for a non-contrast brain or head CT scan? The solution is simple! Just follow these billing tips:
Remember the Basic Requirement
As we have stated numerous times, CPT code 70450 refers to a computed tomography of the brain or head without contrast material. Therefore, avoid using this code for every CT scan.
Justify the Medical Necessity of a Non-Contrast CT Scan
You know exactly what you need to do to justify a medical service or test: maintain proper documentation. In simple words? Your documentation must defend why you performed a CT scan without contrast material. Therefore, you must record the following details:
- Patient’s symptoms with appropriate ICD-10 codes (dizziness, severe headache, seizures, nausea).
- Reason for performing the test (head trauma, suspected brain hemorrhage, or tumor).
- Justification for performing a CT scan without contrast (allergic reaction, age factor, or unnecessary).
- Test details (who performed the test and who interpreted it).
- Relevant findings.
Attach Appropriate Modifiers to 70450
You know how essential modifiers are for conveying important information about any service or test, including a CT scan. Therefore, use appropriate modifiers with CPT code 70450. If you are billing for the technical and professional components of this imaging study separately, don’t forget to use modifiers TC and 26 with this code.
Review Coverage Policies and Payer Requirements
Our final tip? Review the latest local coverage determinations (LCDs) and payer-specific requirements before filing a claim for CPT code 70450. Some insurance payers may require prior authorizations for CT scans, especially for repeated tests. Therefore, thoroughly read patients’ insurance plan benefits and visit each payer’s website to confirm their billing requirements.
Summary
So, that’s everything you need to know about CPT code 70450! Need a quick recap? Just remember that you can use this code to bill for a brain or head CT scan without contrast. You can use 70450 for imaging studies with contrast material. As can be seen from our guide, this code is pretty straightforward to use.
But we know that billing mishaps can happen at any stage. Therefore, we have provided three real-world examples and highlighted the best billing practices and applicable modifiers. However, don’t worry if you still cannot handle the billing pressure, as outsourcing is always a viable option. Simply hand over everything to a company with reliable radiology billing services and enjoy timely payments.
