Tasked with a computed tomography (CT) scan, but don’t know which code to use? You are not alone. Radiology billing is a vast domain and contains hundreds of different codes for seemingly similar procedures. One such procedure is a CT scan of the thorax.
Want to learn more about how to bill a thorax CT scan? Then this guide is for you. Our billing experts at MediBillMD have created this comprehensive guide on a specific kind of computed tomography, i.e., CT scan of the thorax, represented by CPT code 71250.
Let’s discuss this code in more detail!
CPT Code 71250 – Description
CPT code 71250 is a radiology billing code. It is used for a computed tomography (CT) scan of the thorax performed without contrast material. While the definition is self-explanatory, let’s try to break this down in simpler terms.
71250 represents a simple CT scan of the thorax, or chest area. It is used to create detailed cross-sectional images of the chest cavity, including the lungs, heart, mediastinum, pleura, and chest wall structures. It is important to note that intravenous contrast material is not administered during the imaging process.
If a CT scan of the thorax is performed with contrast, you must use different and more appropriate codes, like CPT code 71260.
Here is a quick overview of what happens during the scan.
The procedure involves the patient lying on a table that moves through a donut-shaped CT scanner. X-ray beams rotate around the patient, creating multiple images that are processed by a computer to generate detailed cross-sectional views. The entire scan typically takes between 10 and 30 minutes to complete.
Scenarios Where CPT Code 71250 is Applicable
Knowing the description is one thing, but the key to effective use is learning when and where to use CPT code 71250. The following are some common real-world clinical scenarios where CPT code 71250 may be medically necessary:
Emergency Medicine
Emergency departments frequently utilize CPT code 71250 for trauma patients to evaluate chest injuries, assess for pneumothorax, or rule out pulmonary embolism when contrast studies are contraindicated.
Infectious Disease
71250 also applies when evaluating suspected tuberculosis, fungal infections, or atypical pneumonias. Healthcare providers also use it to report the monitoring of treatment response in patients with complex respiratory infections.
Oncology Applications
Cancer treatment and diagnosis are also areas in which code 71250 applies. Providers perform a chest CT scan to monitor treatment response or detect recurrence. In oncology, it is particularly useful for patients with a history of lung cancer, breast cancer, or other malignancies that commonly metastasize to the lungs, like malignant neoplasm of the esophagus (C15.9) or neoplasm of peripheral nerves of the thorax (C47.3).
Applicable Modifiers for CPT Code 71250
The following modifiers are most commonly used with CPT code 71250:
| Modifier | Description | Application |
|---|---|---|
| 26 | Professional Component | Used when the physician interprets the results but does not own the equipment. |
| TC | Technical Component | Used when billing only for the technical aspects of the procedure (equipment, technician, supplies). |
| 52 | Reduced Services | Used when the service is partially reduced or eliminated. |
| 59 | Distinct Procedural Service | Used when the procedure is distinct from other services performed on the same day. |
| 76 | Repeat Procedure, Same Provider | Used when the same provider repeats the procedure on the same day. |
| 77 | Repeat Procedure, Another Provider | Used when a different provider repeats the procedure on the same day. |
CPT Code 71250 – Billing & Reimbursement Guidelines
Now that you understand what CPT code 71250 is and where to use it, let’s discuss the “How” of the equation. Medical billing is an intricate process and includes several steps. Each step of the process should justify your selection of 71250 to make your claim acceptable. The following are some things to keep in mind while filing CPT code 71250 claims:
Provide Detailed Supporting Documentation
For CPT code 71250 to be considered medically necessary, the patient’s medical record must clearly document:
- Beneficiary’s name
- Date of service (DOS)
- Signed order or intent to order for chest CT scan from the ordering provider
- Documentation from the ordering provider supporting the indication/ medical necessity of the scan
- Signed radiology report providing evidence of service rendered by the billing provider
- Appropriate signatures and credentials of the person rendering the services
- Specific signs, symptoms, or conditions warranting the chest CT scan without contrast
- Relevant patient history, physical exam findings, and previous imaging results
Check the Reimbursement Amount
The reimbursement amount for CPT code 71250 is heavily dependent on the Medicare Administrative Contractor (MAC) locality, facility settings, and the appended modifiers. According to the latest Medicare reimbursement rates, the national average reimbursement amount for 71250 for non-facility settings is $131.00.
You can check the Medicare reimbursement amount for your MAC locality via the PFS Lookup Tool.
