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Radiology Coding Alert

Reader Question:
Image Fusion Requires Multiple Codes

Question: Is there a single correct code to describe image fusion? Our office manager has instructed us to use 76375 (Coronal, sagittal, multiplanar, oblique, 3-dimensional and/or holographic reconstruction of computerized axial tomography, magnetic resonance imaging, or other tomographic modality). Is this right? California Subscriber Answer: During the course of the treatment planning process, the radiation oncologist may need to "fuse" images obtained through different modalities in order to get a "big picture." In some situations such as when a CT scan is taken following surgery for tumor removal or after chemotherapy to reduce tumor volume relying on CT images alone may miss the correct target volume.

Image fusion provides an overall anatomic and/or functional representation of the tumor volume and related structures. Additional data provided by other imaging modalities can be added to or literally placed on top of the CT scan in order to obtain a more specific discernment of the tumor location. There is no code that accurately describes the fusion procedure; therefore, you must rely on an unlisted-procedure code. When the work involved to perform the image fusion requires a significant investment in time or resources (above and beyond the time and effort required for 3-D planning), most experts agree that you should use one of the following codes:
77299 Unlisted procedure, therapeutic radiology clinical treatment planning, for the professional component 77399 Unlisted procedure, medical radiation physics, dosimetry and treatment devices, and special services, for the technical component. The October 2002 ACR (American College of Radiology) Bulletin recommends 77370 (Special medical radiation physics consultation) for image fusion. Do not use 76375. This reconstruction code is to be used only in addition to a diagnostic imaging procedure; therefore, it would not be appropriate to assign this code for the remanipulation of images in a 3-D planning system or for image fusion.

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