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Radiology Coding Alert

Reader Question:
Temporal Bone CT Is Bundled Into Head CT

Question: We performed a CT of the temporal bones along with a CT of the head, but we can't find a temporal bone CT code in CPT. What should we report?

Arkansas Subscriber Answer: You can report a CT scan of the temporal bones using either 70480 (Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material), 70481 (... with contrast material[s]) or 70482 (... without contrast material, followed by contrast material[s] and further sections).
The National Correct Coding Initiative bundles these codes into the head CT codes (70450-70470), however, so you shouldn't report them together unless the radiologist determined that one was a separate and distinct procedural service from the other. If that is the case, you should append modifier -59 (Distinct procedural service) to the temporal bone CT scan code. The order for the scanning services should clearly state the medical necessity for both CT studies. Some practices perform a separate and distinct imaging exam for the temporal bones with different positioning and views than with head CT scanning. If the request justifies obtaining both exams, and two separate exams are performed, modifier -59 modifier would be appropriate.  - The answers for You Be the Coder and Reader Questions were reviewed by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Dallas, Ga; and Gary S. Dorfman, MD, FACR, FSIR.