Want to bill a chest CT scan, but not sure which code to use? You are not alone. Many billers face the same situation. Thoracic computed tomography is mainly billed with three CPT codes. Each code represents a slight variation of the procedure and often confuses the billers.
One of these codes is CPT code 71260. In this guide, we have tried our best to clear your concepts regarding thorax CT scans. We will provide a detailed explanation of the code, the difference between the three codes, applicable modifiers, and some important billing guidelines.
So, let’s start.
CPT Code 71260 – Description
CPT code 71260 is officially defined as:
“Computed tomography, thorax; with contrast material.”
To better understand the billing procedure and requirements, let’s first break this down in more detail.
Code 71260 is used in radiology billing to bill a computed tomography (CT scan) of the chest area to create a detailed cross-sectional image. The important point to note here is that, unlike simple CT scans, 71260 involves the use of contrast material to provide better visualization of blood vessels, soft tissues, and other anatomical structures.
Normally, the radiologists use iodine-based contrast for the procedure. The contrast dye is injected into the patient intravenously before the scan. The description seems simple enough. However, many billers get confused during the code selection. So, we must clarify the difference between the codes.
The following are the CPT codes for chest-related CT scans:
- CPT code 71250: Thorax CT scan without contrast material
- CPT code 71260: Thorax CT scan with contrast material
- CPT code 71270: Thorax CT scan without contrast, followed by scans with contrast material
Scenarios Where CPT Code 71260 is Applicable
To make things clear, let’s look at a couple of real-world scenarios in which CPT code 71260 can be used.
Amebic Lung Abscess
Suppose a 45-year-old man comes to the emergency room. He has had a persistent fever, productive cough with bloody sputum, and severe chest pain for the past week. Upon inquiry, the patient reveals that he recently returned from a tropical region where he experienced gastrointestinal symptoms.
Initial chest X-rays show suspicious pulmonary lesions. However, X-ray imaging is unable to detect the actual problem and nature of the lesions. Standard antibiotic treatments for bacterial pneumonia show no improvement in the patient’s deteriorating condition.
Considering the recent travel and symptoms, the physician suspects a parasitic lung infection, specifically an amebic lung abscess. To confirm the diagnosis, he orders a contrast-enhanced CT scan of the chest. The billing department can use CPT code 71260 in this case to bill the CT scan.
Pulmonary Anthrax
Let’s consider another scenario. Suppose a man who works in the wool processing industry comes to the ER. He complains of severe breathing distress that was initiated suddenly. The man also has a high fever and a non-productive cough. For a quick checkup, the physician in the ER performs a chest X-ray. The X-ray comes out concerning and shows bilateral pleural effusions. Plus, the patient is not responding to mild medications, and his condition is deteriorating quickly.
This raises suspicion of a more severe underlying condition. So, the physician orders a detailed chest CT scan with contrast. The scan provides high-quality images of the thorax, and the physician confirms a case of pulmonary anthrax. The CT scan in this case can be billed with CPT code 71260.
Applicable Modifiers for CPT Code 71260
You can append the following modifiers to CPT code 71260:
| Modifier | Description | Application |
|---|---|---|
| TC | Technical Component | Used when billing only for the technical aspects of the procedure (equipment, technician, supplies). |
| 26 | Professional Component | Used when the physician interprets the results but does not own the equipment. |
| 52 | Reduced Services | Used when the service is partially reduced or eliminated. |
| 59 | Distinct Procedural Service | Indicates CT scan is separate and distinct from other procedures 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 71260 – Billing & Reimbursement Guidelines
Applying the correct code, but still getting hit with denials? The problem may be the minor details that you are missing. Here is what you should keep in mind when billing for CPT code 71260:
Provide Detailed Documentation
For 71260, you must append the following details to your claims. :
- Patient’s name
- Date of service
- Written request from the physician who ordered the CT scan
- Notes explaining why the patient needs the scan
- Official results written by the radiologist
- Proper signatures from qualified medical staff
- List of symptoms
- Patient’s health history and any previous test results
Check the Reimbursement Amount
The reimbursement amount for CPT code 71260 varies for each MAC locality. The national average reimbursement amount for 71260 is $164.32 in non-facility settings.
The following is a more detailed breakdown of the cost structure:
- Professional component:
- Facility price: $53.05
- Non-facility price: $53.05
- Technical component:
- Non-facility price: $111.27
You can check the exact reimbursement rate for your MAC locality via the PFS Lookup Tool.
Justify with Valid ICD-10 Codes
Attaching the right documentation is not enough. Your claims must include valid and relevant ICD-10 codes to support the medical necessity of the CT scan.
Common diagnosis codes used with CPT code 71260 include:
- A15.9: Respiratory tuberculosis unspecified
- A18.01: Tuberculosis of the spine
- A18.84: Tuberculosis of the heart
- A19.9: Miliary tuberculosis, unspecified
- A22.1: Pulmonary anthrax
- A31.0: Pulmonary mycobacterial infection
To get the complete list of ICD-10 codes that justify medical necessity for code 71260, you can check the official CMS guide on Computerized Axial Tomography (CT), Thorax.
Wrapping Up
In this blog, we tried our best to simplify CPT code 71260 for you. By implementing the best practices outlined in this guide, you can avoid claim denials and get fair reimbursement for your services.
However, if you are facing continuous denials or do not have a specialized radiology billing team, you can always seek professional help. Many billing companies like MediBillMD offer affordable radiology billing services to help reduce your administrative workload.
