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Coronary CT Angiography
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RCS Archive
Jan/Feb 2005
Early in the evolution of coronary CT angiography, when the work and practice expense were not
clearly established, the American College of Radiology recommended that coronary CTA be coded as
a conventional chest CT angiogram, using CPT® code 71275 (Computed tomographic angiography,
chest, without contrast material(s), followed by contrast material(s) and further sections, including
image post-processing). Since that time, it has become apparent that the CT techniques for highquality coronary CTA are vastly different from the examinations described by 71275 with respect to
field of view, slice thickness, gating requirements, reconstruction algorithms, and even scanner
requirements. For this reason 71275 should not be used to describe dedicated CT and CTA of the
heart and coronary vasculature. Instead, the ACR now recommends that the unlisted CPT code
76497 (Unlisted computed tomography procedure (eg, diagnostic, interventional)) be used to
describe the CT evaluation of the coronary vasculature, as well as the other special cardiac CT and
CTA examinations under development.
Coronary CTA is typically performed as a stand-alone examination dedicated to the evaluation of the
coronary arteries, and it has the potential to supplant conventional catheter angiography for many
patients. The CTA of the chest code, 71275, was valued to address imaging and angiographic
reconstruction of the noncoronary thoracic vessels (eg, rule out pulmonary embolism and aortic
dissection). It was not valued to address coronary artery evaluation. The typical acquisition and
post-processing protocols used for pulmonary embolism or aortic dissection do not supply the
information needed for exclusion of coronary artery occlusive disease. To obtain this additional
information, acquisition and post-processing algorithms dedicated to evaluation of coronary vessels
are used instead of those employed for a conventional CTA of the chest examination. That is why
the ACR is now recommending that the unlisted code 76497 be used to describe coronary CTA. The
use of the unlisted procedure code is used in the CPT® process to collect data on new procedures to
determine the extent of use across the United States.
In certain emergency cases of acute chest pain, CTA is occasionally used to evaluate for the
presence of pulmonary embolism, aortic dissection, and coronary artery stenosis. This application of
CTA, commonly referred to as a "triple ruleout™ study," consists of a combination of two separate
noninvasive examinations: CTA examination of the aorta and pulmonary vasculature, and CTA
examination of the coronary vasculature. When a CTA study is performed to evaluate the aorta,
pulmonary vasculature, and coronary vasculature, it is recommended that 71275 be reported to
describe the conventional CTA (ie, evaluation of the aorta and pulmonary vessels), and that the
unlisted procedure code 76497 be reported to describe the examination of the coronary circulation.
CPT® codes 71275 and 76497 are not mutually exclusive and may be reported by the same
physician for the same patient on the same date of service.
The ACR is working with the American College of Cardiology to create a new CPT® code to describe
coronary CT angiography. The earliest a new code could be developed is 2007 for a Category I code
or 2006 for a Category III code. Until a new code is created, the position of the ACR is that, unless
a specific payer has advised otherwise (some private payers are requesting use of the temporary
HCPCS code S8093), coronary CT angiography should be coded as an unlisted computed
tomography procedure (76497).
For a detailed discussion of CTA and CT in conjunction with CTA, please reference the May/June
2003 ACR Radiology Coding Source™ feature article. For the coding of other specific thoracic
vascular CT and MR applications, please reference the table below.
PROCEDURE
CODE DESCRIPTOR
COMPUTED
TOMOGRAPHY
Conventional CT of the chest
(eg, for pulmonary embolism
and/or aortic dissection, when
no angiographic postprocessing
is performed)
71250
Computed tomography, thorax; without
contrast
material
71260
71270
with contrast material(s)
without contrast material, followed by
contrast material(s) and further sections
Conventional chest CTA (eg,
71275 Computed tomographic angiography,
for pulmonary embolism and/or
chest, without contrast material(s),
aortic dissection, when
followed by contrast material(s) and
angiographic postprocessing is
further sections, including image
performed)
postprocessing)
Coronary CTA
76497 Unlisted computed tomography
procedure (eg, diagnostic,
interventional)
Combined conventional chest
and coronary CT angiography
(eg, for evaluation of aorta,
pulmonary vasculature and
coronary circulation - referred
to by some as a "triple
ruleout™" CTA study)
71275
Cardiac Mapping (cardiac
scoring)
76497 Unlisted computed tomography
procedure (eg, diagnostic,
interventional)
Computed tomographic angiography, chest,
without contrast material(s), followed by
contrast material(s) and further sections,
+
including image postprocessing)
Unlisted computed tomography procedure
76497
(eg, diagnostic, interventional)
MRI of the heart is currently differentiated from MRI and MRA of the chest. Please reference the
following table for a listing of MRI codes.
PROCEDURE
MAGNETIC RESONANCE
IMAGING
CODE DESCRIPTOR
MRI of the chest
71550
Magnetic resonance (eg, proton) imaging,
chest (eg, for evaluation of hilar and
mediastinal lymphadenopathy); without
contrast material
71551
with contrast material
71552
without contrast material, followed by with
contrast material(s) and further sections
MRA of the chest
Magnetic resonance angiography,
71555 chest (excluding myocardium), with
or without contrast material(s)
Cardiac MRI for morphology
75552
(Useful in assessment of the heart
Cardiac magnetic resonance imaging for
morphology, without contrast material
structure for diagnostic evaluation
of congenital heart disease,
75553
with contrast material
pericardial disease, tumors,
cardiomyopathies, valvular heart
disease, and ischemic heart
disease)1
Cardiac MRI for function
75554
(Codes used to describe
function, with or without morphology;
observation of cardiac function
with or without observing
Cardiac magnetic resonance imaging for
complete study
75555
limited study
morphology.)1
Cardiac MRI for mapping
(Used to assess the great vessels,
75556 Cardiac magnetic resonance imaging
for velocity flow mapping
including the thoracic aorta (for
detection of aneurysm, dissection,
or co-arctation), the main
pulmonary artery (to assess its
size), and the relationship between
these two vessels (to assess
patients with congenital heart
disease).1
MRA of the heart
76498 Unlisted magnetic resonance
procedure (eg, diagnostic,
interventional)
For additional information on MRI and MRA of the heart, please reference the CPT® Assistant, Fall
1995 issue.
CPT® Assistant, Fall 1995
1