Ask Dr. Z

What is your recommendation on coding the following study for hyperparathyroidism with after study no CT evidence of parathyroid adenoma? Technique: 4D parathyroid protocol axial CT images of the neck were performed after the intravenous administration of 80 mL of Isovue 300. Coronal and sagittal reformations were provided. An adaptive iterative reconstruction technique was utilized for dose reduction.

Should this be coded as a CT soft tissue neck w/contrast 70491 or does the "4D" technique indicate at least 3D imaging was performed and this should be coded as 70491 & 76376? We cannot find any information on how to code "4D" technique CT exams, and this technique does not seem to meet the 3D code requirements so would seem to only be coded as 70491. Any guidance you can provide on coding "4D" CT exams would be very appreciated.