3D Reconstruction Clarification: Part II

ADVOCATE recently released a Coding Insights article titled 3D Reconstruction Clarification with clarification on the revision to the language of the 3D reconstruction codes, 76376 & 76377.  Specifically, the article clarified the definition of “concurrent supervision”.  Due to the number of questions generated from the initial publication, we are providing answers to some frequently asked questions and are providing recommended report language for these studies.

As noted in the previous article, in CPT 2013, new verbiage has been added to both 3D reconstruction codes, providing clarification that image post-processing must be done under concurrent supervision. 

76376: 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image post-processing under concurrent supervision; not requiring image post-processing on an independent workstation

76377: 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image post-processing under concurrent supervision; requiring image post-processing on an independent workstation  

Concurrent is defined as “active participation in and monitoring of the reconstruction process that includes: design of the anatomic region that is to be reconstructed; determination of the tissue types and actual structures to be displayed (e.g., bone, organs, and vessels); determination of the images or cine loops that are to be archived; and monitoring and adjustment of the 3D work product”.

Break Away from the Static

Q:  Regarding concurrent supervision, what is required of the physician?

A:  The physician must actively participate in the reconstruction process.  He or she must either do the reconstructions personally or direct the technologist to the area to be reconstructed, decide on the structures to be displayed, and otherwise monitor the process.

Q:  What is the difference in the role of the physician for the 2 codes?

A:  The distinction between these 3D codes is the difference in work involved and the role of the interpreting physician.

  • For 76376 (3D reconstruction NOT requiring image post-processing on a separate workstation), the physician will discuss the need with the technologist for 3D imaging and supervise the technologist in creating 3D images.
  • For 76377 (3D reconstruction requiring image post-processing on a separate workstation), the physician will supervise and/or create the 3D reconstructions and adjust the projection to optimize visualization of anatomy or pathology.

Q:  Does the concurrent supervision concept apply when determining protocols?  For example, if the radiologist creates the protocol for the technologist for a given scenario, would this be sufficient?

A:  This would not be sufficient.  The utilization of these codes is dependent on medical necessity, which should be determined by the referring physician and the radiologist and should be on a case by case basis.  Based on the guidelines for these codes, the active participation and specific anatomic regions to be imaged would likely change based on the patient’s specific condition.

Q:  What is the recommended language in the report for these studies?

A:  Because the dictated report, not the images, is the radiologist’s legal source document for the services billed, clearly documenting the concurrent supervision in the report is essential.

For example, when 3D rendering is performed on a separate workstation, ADVOCATE recommends stating something similar to the below statement:

“3D reconstruction was performed on a separate workstation under concurrent supervision.”

This statement leaves no question for a coder, auditor, or payer as to the involvement of the physician in the reconstruction process. 

Best regards,
Jennifer Bash, RHIA, CPC, CIRCC, RCC 
Coding & Documentation Education Manager

Debby Crow, CPC, RCC, ROCC
Coding & Documentation Education Manager