Operational Considerations of the CTA Head and Neck...

Operational Excellence Operational Considerations of the CTA Head and Neck Coding Changes March 17, 2026 - Melody W. Mulaik, CRA, FAHRA

The start of the new year brought many CPT® procedure code updates. As is often the case with code changes in the Radiology section of the CPT Manual, the updates extend beyond simply learning new code numbers. Organizations must also evaluate operational workflows, documentation practices, and charge capture processes to ensure services are reported accurately and compliantly.

Two of the most significant changes for imaging involve CT angiography (CTA) of the head and neck and CT cerebral perfusion analysis. While these updates may appear straightforward, they introduce important distinctions that can affect coding accuracy, documentation requirements, and claim submission workflows.

Now that these codes are active, imaging departments should ensure that their systems, staff education, and monitoring processes support the correct reporting of these services. The following discussion outlines the major changes and highlights operational considerations that organizations should be reviewing as these codes are implemented.

A Closer Look at the New Combination Code 70471

One of the most notable updates for 2026 is the creation of a new combination code for CT angiography of the head and neck when imaging of both anatomical regions is performed during the same study.

Prior to 2026, organizations reported separate codes when CTA imaging included both the head and the neck. When CTA imaging includes evaluation of both the head and neck during the same encounter, the combined code 70471 (Computed tomographic angiography (CTA), head and neck, with contrast material(s), including noncontrast images when performed, and image postprocessing) should now be reported.

The existing codes, 70496 (head) and 70498 (neck), remain valid but are now used only when imaging is limited to a single region. In other words, when a CTA study evaluates both regions in a single exam, 70471 should be assigned instead of reporting 70496 and 70498 together.

Another important guideline is that the combined CTA code should not be reported with CT head, CT neck, or 3D reconstruction codes (76376, 76377). The work represented by these services is included in the CTA procedure code and reporting them separately would be considered unbundling.

What This Means for Imaging Organizations in Practice

While the coding rule itself is relatively simple, the operational implications within imaging departments and organizations can be more complex.

Whenever a new CPT® code replaces an established reporting structure, organizations must ensure that their internal systems and workflows support the updated coding rules.

Many imaging departments historically configured their Radiology Information Systems (RIS) or billing workflows to automatically pair the head and neck CTA codes when both regions were imaged. Under the new guidelines, those automated pairings should no longer occur.

Changes to Reporting Structure

In addition to the combination head/neck CTA code, the CPT® code set also introduced a new reporting structure for CT cerebral perfusion analysis.

The previous Category III code 0042T was deleted and replaced with two Category I codes that distinguish whether perfusion analysis is performed with or without concurrent CT or CTA imaging of the head. The new codes are +70472 (CT cerebral perfusion analysis with concurrent CT or CT angiography of the head) and 70473 (CT cerebral perfusion analysis without concurrent CT or CT angiography of the head).

The distinction between these codes is important. Code +70472 is an add-on code and must always be reported with a primary CT or CTA study of the head. It cannot be reported as a standalone service.

If cerebral perfusion analysis is performed independently without concurrent CT or CTA imaging, code 70473 should be reported.

As with the CTA codes, perfusion services should not be reported with 3D reconstruction codes.

How Imaging Teams Can Ensure Coding Compliance

To ensure appropriate implementation, organizations should ensure that the following operational steps have been completed:

Charge description master (CDM) updated to include the new codes and prevent the selection of the deleted code 0042T.
Order sets were modified so staff can clearly select head-only, neck-only, or combined CTA studies for the head and neck.

Implemented system logic requiring a primary CT or CTA head code when +70472 is selected to ensure that the add-on code cannot be assigned as a standalone service.

RIS/PACS prompts configured to guide correct exam selection.
- Some organizations may also incorporate a coding decision tree within their workflow tools to assist staff with selecting the correct code based on whether a concurrent CT or CTA study was performed.
Removal of automated pairing of 70496 and 70498 when both regions are imaged together.

These adjustments help prevent incorrect code assignment at the point of charge capture and reduce the likelihood of coding corrections later in the revenue cycle.

How Coding Changes Impact a Variety of Roles

Coding changes rarely affect only a single group within the organization. Successful implementation requires communication and education across multiple stakeholders.

Coders must be familiar with the new reporting rules and recognize when the combined code is appropriate. Technologists should understand how exam selection in the RIS may affect charge capture. Ordering providers may also benefit from understanding when a combined study is appropriate and how documentation supports the exam.

Identifying Risks Early On

Whenever coding changes occur, there are predictable scenarios where errors may arise. Identifying these risks early allows organizations to implement safeguards to prevent incorrect claims submission.

Some of the primary denial risks associated with the new combined head/neck CTA code include:

Continuing to report 70496 and 70498 together instead of using the combined code,
Reporting CT head or CT neck codes in addition to the CTA study, and/or
Reporting 3D reconstruction codes with CTA services.

For the new perfusion codes, some denial risks include:

Continuing to report the deleted code 0042T,
Reporting +70472 without a primary CT/CTA code,
Reporting 70473 when a concurrent CT or CTA study was performed, and/or
Reporting perfusion codes with 3D reconstruction services.

Regardless of coding changes, the radiologist’s dictated report remains the primary support for procedure code assignment. For the combination head/neck CTA studies, the report should clearly document imaging of the head and neck vascular structures, contrast administration, and image postprocessing.

For cerebral perfusion studies, documentation should also confirm that cerebral perfusion analysis was performed, whether concurrent CT or CTA imaging occurred, and the clinical indication, particularly in time-sensitive stroke scenarios.

Additional Compliance Checks

Organizations may also benefit from implementing additional compliance controls such as pre-bill coding validation, random retrospective audits, and denial root-cause analysis tied to education initiatives. These measures help ensure that even the most prepared organizations identify potential workflow gaps that were not previously identified.

Additionally, imaging departments should monitor key indicators such as CTA denial rates by CPT® code, payer feedback trends, and frequency of coding corrections. Monitoring claims during the first 60–90 days after implementation can help identify potential issues early and allow organizations to provide additional education where necessary.

Procedure Codes: Where Revenue, Compliance, and Patient Care Meet

Coding updates are a constant in healthcare, and imaging professionals must continually adapt to evolving reporting requirements. The new CPT® codes for CTA of the head and neck and CT cerebral perfusion represent important changes that now affect how these services are documented, coded, and billed.

Although the coding changes themselves are relatively straightforward, the operational implications can be significant. Updating internal systems, providing targeted education, and monitoring claims during the early implementation period can help ensure accurate reporting and reduce denial risk.

As always, it is important to remember that procedure codes translate directly into both revenue and compliance for an organization. Ensuring that imaging services are reported correctly benefits providers, facilities, and ultimately the patients receiving care.

DISCLAIMER: CPT® is a registered trademark of the American Medical Association. CPT® five-digit codes, nomenclature, and other data are copyright 2025 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in the CPT® book. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for the data contained herein or not contained herein.

Melody W. Mulaik, CRA, FAHRA R3

Melody W. Mulaik is chief operating officer of R3, powering RCCS, Regents and RC Billing. She is a nationally recognized speaker and has delivered numerous presentations at AHRA annual meetings and conferences. Melody is a member of AHRA and has published extensively. She may be contacted at melody.mulaik@rccsinc.com.