Ask Dr. Z

Can 3D post-processing be coded with kyphoplasty and vertebroplasty procedures? Currently there are no NCCI edits. Would this be considered included “procedural guidance”?

Per the SIR, 3D post-processing “requires documentation of diagnostic uncertainty prior to initiation of the procedure as well as the subsequent imaging findings and their significance. Determining the best approach to a lesion is not diagnostic imaging; determining whether a lesion exists is.” Per the NCCI Policy Manual Chapter 9.D.15, 3D rendering shall not be reported for mapping sites of biopsies or needle placements. Would 3D post-processing be considered “mapping” for kyphoplasty or vertebroplasty since it is already known the vertebra needs treating?

If 3D post-processing can be reported, what type of documentation is required to support billing for this service? We are thinking if 3D is performed prior to intervention then yes, and if during or after then no since bundled, but there are differences in opinion between physician and coders on this and we are seeking clarification.