One acquisition produces two reports

Read an original fictional chart, identify the supported facts, and explain your coding workflow.

Chart gym · Original fictional record

Service date: 2026-09-09 · Outpatient diagnostic or treatment service; stated component and Medicare relationship

Use your code books and write your reasoning before opening the walkthrough. This exercise contains no real patient information.

Technical examination

Synthetic adult undergoes an ordered chest CTA to evaluate suspected pulmonary embolism. One contrast-enhanced technical acquisition is obtained using the angiographic protocol. No separate routine chest CT acquisition or second encounter occurs.

Image processing

The radiologist reviews both vascular reconstructions and lung-window images from that same acquisition. The practice creates a CTA report and an additional report labeled chest CT from the same data. The second report has no separate technical study behind it.

Coding context

The clinician’s order and the completed examination must still support the appropriate selected study. This exercise tests the one-acquisition relationship, not whether every CT and CTA pairing is always prohibited. A different record with separate necessary studies would require its own review.

Claim proposal

The draft reports both CT and CTA of the region because there are two reports. Compare report count with actual technical acquisition. Apply NCCI’s stated relationship and then identify the applicable full entry for the completed service.

Your coding worksheet

Count the technical studies actually performed.
Distinguish reconstruction from a second acquisition.
Evaluate reporting both CT and CTA.
Explain what facts would require another review.

In your notebook, record the supported facts, your index route, the instructions you checked, and any missing detail that limits your answer.

Compare with the worked explanation

Only one technical study is documented.
The second report and reconstructed views come from the same acquisition.
NCCI D.9 permits one applicable procedure for that region in this relationship, rather than both CT and CTA.
Separate, medically necessary technical studies or encounters would require a different complete review; they cannot be inferred from report count.

Reference sections: D.9

Practice the linked chart questions