CPT 71275 AND 74174

 CPT Code    Description

71275       Computed tomographic angiography, chest (non-coronary), with contrast material(s), including noncontrast images, if performed, and image post-processing 

CPT Code Acceptable S/S Procedure to Pre-Cert

71275 * Thoracic Aortic Dissection

* Thoracic Aortic Aneurysm

* Coarctation

* Aortic Root Dilation CTA Chest

74174 * Abdominal Aortic Dissection

* Mesenteric Ischemia

* Bowel Ischemia

* Stent Obstruction CTA Abdomen and Pelvis

* Thoracic Abdominal Aortic Dissection requires both codes 71275 and 74174

CPT Codes: 71275

Computed tomography angiography (CTA) is a non-invasive imaging modality that may be used in the evaluation of thoracic vascular problems. Chest CTA (non-coronary) may be used to evaluate vascular conditions, e.g., pulmonary embolism, thoracic aneurysm, thoracic aortic dissection, aortic coarctation, or pulmonary vascular stenosis. CTA depicts the vascular structures as well as the surrounding anatomical structures.

Initial Clinical Reviewers (ICRs) and Physician Clinical Reviewers (PCRs) must be able to apply criteria based on individual needs and based on an assessment of the local delivery system.

INDICATIONS FOR CHEST CTA:

For evaluation of suspected or known pulmonary embolism (excludes low risk*)

For evaluation of suspected or known vascular abnormalities:

* For evaluation of a thoracic/thoracoabdominal aneurysm or dissection (documentation of clinical history may include hypertension and reported “tearing or ripping type” chest pain.

* Congenital thoracic vascular anomaly, (e.g., coarctation of the aorta or evaluation of a vascular ring suggested by GI study).

* Signs or symptoms of vascular insufficiency of the neck or arms (e.g., subclavian steal syndrome with abnormal ultrasound).

* Follow-up evaluation of progressive vascular disease when new signs or symptoms are present.

* Primary or secondary pulmonary hypertension.

Preoperative evaluation

* Known or suspected vascular abnormalities seen on prior imaging

* Ablation procedure for atrial fibrillation.

Postoperative or post-procedural evaluation

* Physical evidence of post-operative bleeding complication or re-stenosis.

* Post-surgical follow up when records document medical reason requiring additional imaging

Chest CTA and Abdomen CTA or Abdomen/Pelvis CTA or Pelvis CTA combo:

* For evaluation of extensive vascular disease involving the chest and abdominal cavities such as aortic dissection, vasculitic diseases such as Takayasu’s arteritis, significant post-traumatic or postprocedural vascular complications, etc.

* For preoperative or preprocedural evaluation such as transcatheter aortic valve replacement (TAVR).

ADDITIONAL INFORMATION RELATED TO CHEST CTA:

CTA and Coarctation of the Aorta – Coarctation of the aorta is a common vascular anomaly characterized by a constriction of the lumen of the aorta distal to the origin of the left subclavian artery near the insertion of the ligamentum arteriosum. The clinical sign of coarctation of the aorta is a disparity in the pulsations and blood pressures in the legs and arms. Chest CTA may be used to evaluate either suspected or known aortic coarctation and patients with significant coarctation should be treated surgically or interventionally.

CTA and Pulmonary Embolism (PE) – Note: D-Dimer blood test in patients at low risk* for DVT is indicated prior to CTA imaging. Negative D-Dimer suggests alternative diagnosis in these patients. *Low risk defined as NO to ALL of the following questions:

1) Evidence of current or prior DVT;

2) HR > 100;

3) Cancer diagnosis;

4) Recent surgery or prolonged immobilization;

5) Hemoptysis;

6) History of PE; and another diagnosis is more likely.

CTA has high sensitivity and specificity and is the primary imaging modality to evaluate patients suspected of having acute pulmonary embolism. When high suspicion of pulmonary embolism on clinical assessment is combined with a positive CTA, there is a strong indication of pulmonary embolism. Likewise, a low clinical suspicion and a negative CTA can be used to rule out pulmonary embolism. CTA and Thoracic Aortic Aneurysms – Computed tomographic angiography (CTA) allows the examination of the precise 3-D anatomy of the aneurysm from all angles and shows its relationship to branch vessels. This information is very important in determining the treatment: endovascular stent grafting or open surgical repair.

CTA and Thoracic Aorta Endovascular Stent-Grafts – CTA is an effective alternative to conventional angiography for postoperative follow-up of aortic stent grafts. It is used to review complications after thoracic endovascular aortic repair. CTA can detect luminal and extraluminal changes to the thoracic aortic after stent-grafting and can be performed efficiently with fast scanning speed and high spatial and temporal resolution.

Chest CT

1. Intrathoracic abnormalities found on chest x-ray, fluoroscopy, abdominal CT scan, or other imaging modalities may be further evaluated with chest CT with contrast (CPT® 71260).

a. “Abnormalities” through these guidelines may include suspected lung or pleural nodules or masses, pleural effusion, adenopathy or other findings that are not considered benign. 

b. Lung nodule(s) identified incidentally on:

i. Chest CTA without and with contrast (CPT® 71275), or

ii. Chest MRI without contrast (CPT® 71550), or

iii. Chest MRI without and with contrast (CPT® 71552), or

iv. Chest MRA without and with contrast (CPT® 71555) can replaceChest CT with contrast (CPT® 71260) or chest CT without contrast (CPT® 71250) as the initial dedicated study

2. Chest CT without contrast (CPT® 71250) can be used for the following:

a. Patient has contraindication to contrast.

b. Follow-up of pulmonary nodule(s).

c. High Resolution CT (HRCT).

d. Low-dose chest CT (CPT® G0297)

3. Chest CT without and with contrast (CPT® 71270) does not add significant diagnostic information above and beyond that provided by chest CT with contrast, unless a question regarding calcification, most often within a lung nodule, needs to be resolved.

4. High resolution chest CT should be reported only with an appropriate code from the set CPT® 71250-CPT® 71270.

a. No additional CPT® codes should be reported for the “high resolution” portion of the scan. The “high resolution” involves additional slices which are not separately billable.

E. Chest CTA (CPT® 71275)

1. Chest CTA (CPT® 71275) can be considered for suspected Pulmonary Embolism and Thoracic Aortic disease.

a. CTA prior to minimally invasive or robotic surgery 

Non-Cardiac Chest Pain Imaging

1. Initial evaluation should include a chest x-ray.1,2

a. If x-ray is abnormal, chest CT with contrast (CPT® 71260) or CTA chest with contrast (CPT® 71275) can be performed.1,2,3,4

 Hemoptysis

A. Chest CT with contrast (CPT® 71260) OR without contrast (CPT® 71250) OR CTA chest (CPT® 71275) may be performed after:

1. Abnormal chest x-ray, or

2. No chest x-ray needed if any of the following:

a. High risk for malignancy with >40 years of age and >30 pack-year smoking history, or

b. Persistent/recurrent with >40 years of age or >30 pack year smoking history, or

c. Massive hemoptysis (=30 cc per episode or unable protect airway).1