April 1, 2022

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Read classmates post and respond with 100 words:

We must understand the the guidelines before coding. Radiology guidlines consits of Professional, Technical, and Global. Radiology is used to diagnose and treat patients. Technical is used for diagnostic imaging examinationsand administering radiation theraphy treatments. Last but not lease is Global and global is reported with a CPT radiology code. An example of Professional can be a x-ray. An example of the Technical is really the equipment, film, and supplies. Then last but not lease the the global is both professional and technical componet which is both equipment and staff who reports.

Carol J. Buck, Saunders (2022). Step-by-Step Medical Coding, by Carol J. Buck, Saunders

CHAPTER 24

RADIOLOGY

Slide ‹#›

Radiology

Radiology: Branch of medicine that uses radiant energy to diagnose and treat patients

Specialist in radiology: Radiologist (doctor of medicine)

Slide ‹#›

Radiology uses radiant energy to diagnose and treat patients.

The term “radiology” originally referred to the use of x-rays to produce radiographs but now it is commonly applied to all types of medical imaging.

A radiologist is a physician (Licensed MD).

Radiologists can provide services to patients independent of or in conjunction with another physician of a different specialty.

Radiology Subsections

Diagnostic Radiology

Aorta and arteries

Diagnostic Ultrasound

Radiologic Guidance

Breast, Mammography

Bone/Joint Studies

Radiation Oncology

Clinical Brachytherapy

Nuclear Medicine

Slide ‹#›

Slide 3 indicates the subsections in the Radiology section of the CPT manual.

Diagnostic Radiology subsection contains the most standard radiographic procedures.

The Diagnostic Radiology subsection and Diagnostic Ultrasound subsection do as their titles say: they assist the physician with the diagnosis process.

Terms

Fluoroscopy views inside of body, projects onto television screen

Live images by which physician can view function and structure of organ

Example: 71047, 76000, Chest x-ray with fluoroscopy

Slide ‹#›

Numerous procedures are covered in the Radiology section.

Fluoroscopy provides live images and allows study of the function of the organ, as well as the structure of the organ.

What is the name for the study of the function of the organ? (Physiology)

What is the name for the study of the structure of the organ? (Anatomy)

Magnetic Resonance Imaging (MRI) (1 of 2)

MRI uses magnetic energy to view soft tissue structures

Example: 72148, MRI of lumbar spine canal

Slide ‹#›

Magnetic resonance imaging (MRI) is the use of nonionizing radiation to show the body in a cross-sectional view.

An MRI allows for observation of soft tissue structures.

MRI codes are divided by with, without, or without followed up with contrast.

The MRI codes are found in the body area that is being viewed.

MRA—Magnetic Resonance Angiography—is application of MRI that provides visualization of blood flow, as well as images of normal and diseased blood vessels

Magnetic Resonance Imaging (MRI) (2 of 2)

Figure 24.12

Modified from Bradley WG, Daroff RB, Fenichel GM, Jankovic J: Neurology in Clinical Practice, ed 5, Philadelphia, 2008, Butterworth-Heinemann.

Slide ‹#›

Fig. 24.12 is an example of an MRA, which indicates blood flow.

Tomography or CT

Tomography used to view single plane of body

Example: 70450, Tomographic scan of head or brain

Slide ‹#›

Tomography, or CT, is the view of a single plane of the body attained by blurring out all other layers.

The codes for CT scans are found under the body area that is being scanned.

CT Scan of Lung Carcinoma

A, A patient with right hilar lung carcinoma and mediastinal adenopathy showing the margins of the bones.

B, The scan can be set to show the soft tissue.

C, The lung organs can be shown by using additional scan settings. There is greater detail than would be obtained with conventional radiographs.

(Courtesy of Bruce Porter, MD.)

Slide ‹#›

This is an example of a CT scan of the lung showing a neoplasm.

Biometry

Biometry: Application of statistical methods to biological facts

Example: 76516, Use of ultrasound echography in biometry of eye

Ultrasound diagnostic noninvasive procedures are performed to determine composition and contours of ocular and orbital structures

Slide ‹#›

Biometry is the application of a statistical method to a biological fact.

Planes of Body

Figure 24.1

Imaginary lines used as points of reference

Slide ‹#›

Terminology that refers to the planes of the body is often used in the Radiology section.

What does this illustration show? (It shows the major planes and the surfaces of the body that can be accessed by positioning the body.)

Position and Projection

Position: Way in which patient placed

Projection: Path x-ray beam travels

Slide ‹#›

What is an example of a position? (Prone: The patient is lying on his or her front [anterior], but the site of entrances and exit of the x-ray beam are not specified.)

What is an example of a projection? (Anteroposterior: The x-ray beam enters the patient’s body at the front and exits from the back.)

Terminology

Radiology uses a wide variety of terms and abbreviations specific to planes, positions, and projections

Slide ‹#›

Many terms are used in the Radiology section to describe planes, positions, and projections. What do some of these terms refer to? (Proximal, distal, lateral dorsal (supine), ventral (prone), decubitus, oblique views, tangential projection, axial projection)

Component Coding

Three component terms

Professional

Technical

Global

Slide ‹#›

Specifically, what are these components? Define each one. (See next three slides.)

Professional Component (-26)

Physician portion of service, includes:

Supervision of technician

Interpretation of results, including written report

From Young AP, Proctor DB: Kinn's The Medical Assistant, ed 10, St. Louis, 2007, Saunders.

Slide ‹#›

The professional component describes the services of the physician, including supervision of the taking of the x-ray film and interpretation of the x-ray films with report.

Modifier -26 if only the professional component is being coded.

Technical Component (-TC)

Technologist’s services

Equipment, film, and supplies

From Long BW, Frank ED, Ehrlich RA: Radiography Essentials for Limited Practice, ed 4, St. Louis, 2013, Saunders.

Slide ‹#›

The technical component describes the services of the technologist and the use of equipment, film, and other supplies.

Modifier -TC is appended if only the technical portion is being coded.

Global Procedure

Both professional and technical portions of radiology service

If facility where procedure was performed owns the equipment and has a radiologist on staff who reads the report—global service

No modifier -TC

No modifier -26

Slide ‹#›

A global procedure includes both the professional and the technical components of the service.

No modifier is required.

Give an example of a global service. (A patient goes to a clinic and has a diagnostic CT scan of the thorax, without contrast (71250). The clinic owns the CT scanner (technical portion) and the radiologist on staff interprets the results (professional component). Here you would bill globally 71250 with no modifier.)

Component Modifiers (1 of 2)

If only professional component of radiology service provided append modifier -26 to code

Slide ‹#›

When only the professional component of the service is provided, the modifier -26 is placed after the CPT code.

If a radiology clinic employs its own technologists and radiologists, the global procedure can be reported.

If a clinic performs only the technical part of the service, and an independent radiologist provides the interpretation and report, the radiologist would report only the professional component of the service, appending the modifier -26 to the code.

Component Modifiers (2 of 2)

If only technical component was provided append modifier -TC to code

Modifier -TC: HCPCS modifier used with CPT and HCPCS codes

Slide ‹#›

If the clinic provides only the technical component, it reports only the technical portion of the service, appending -TC (HCPCS modifier) to the code.

Global Procedure

If both professional and technical components of radiology service provided, use no modifier

Slide ‹#›

If both the professional and the technical components of the service are provided, and therefore a global procedure is reported, no modifier is needed.

For Example: Chest X-Ray

Professional component:

71048-26 (Supervision and final report)

Technical component:

71048-TC (Technician, supplies, equipment)

Global procedure: 71048 (both professional and technical)

Slide ‹#›

For example, for a chest x-ray:

If an independent radiologist provides the professional component, the service is reported with code 71048-26, and the clinic providing the technical component would report code 71048-TC.

If both components were provided, a global procedure would be reported with code 71048.

Global Procedure: reimbursement

Third-party payers usually reimburse

40% professional component

60% technical component

100% global procedure

Slide ‹#›

Why the difference in reimbursement? (Global procedures are paid at 100% of the fee schedule. When the global code is separated with a technical and a professional component, there is a 60% (technical) and 40% (professional) split.)

Contrast Material (1 of 2)

Statement “with contrast” implies injection built into code

Slide ‹#›

Many radiology procedures require that contrast material be injected into the patient to make certain organs or vessels stand out clearly on the radiographic image.

Codes in the Radiology section describe only the radiology procedures, not the injections or placement of other material necessary to perform the procedure.

Codes are often divided according to whether contrast materials were used.

The phrase “with contrast” means that contrast was administered intravascularly, intra-articularly, or intrathecally.

Contrast Material (2 of 2)

Notes indicate codes for components

Example: 75893, venous sampling indicates “(For procedure, use 36500)”

Oral or rectal contrast does not qualify for “with contrast”

Slide ‹#›

The coder must read the notes carefully to determine which codes should be used for components.

If the contrast was administered orally or rectally, the service should be coded as “without contrast.”

The supply of contrast material should be reported with code 99070, and supplies should be assigned codes from the Medicine section.

Overview of Radiology Subsections

Diagnostic Radiology

Diagnostic Ultrasound

Radiologic Guidance

Breast, Mammography

Bone/Joint Studies

Radiation Oncology

Nuclear Medicine

Slide ‹#›

Body areas that are being examined further divide these subsections.

Many of the codes are based on “with contrast,” “without contrast,” or “without contrast followed up with contrast.”

Diagnostic Radiology (1 of 2)

“Complete” in a code description in radiology section, means all views taken of specified body site

Most standard radiographic procedures

Codes often divided on whether contrast material used

Codes further divided on number views

Slide ‹#›

What are the codes used for the Diagnostic Radiology subsection? (70010-76499)

Diagnostic Radiology subsection contains the most standard radiographic procedures.

This subsection contains plain x-rays, CTs, MRIs, and MRAs.

Diagnostic Radiology (2 of 2)

Used to:

Diagnose disease

Monitor disease process—progression or remission

Slide ‹#›

Diagnostic radiology is used to diagnosis disease, evaluate the progression or regression of a disease, or aid in a therapeutic procedure.

Diagnostic Procedures Include

X-ray

Computerized axial tomography (CAT or CT scan)

Magnetic resonance imaging (MRI)

Angiography

Subdural hematoma

CT of renal artery

From Mettler FA: Essentials of Radiology,

ed 3, Philadelphia, 2014, Saunders.

From Mettler FA: Essentials of Radiology,

ed 3, Philadelphia, 2014, Saunders.

From Walsh PC, editor: Campbell's Urology, ed 8, Philadelphia, 2002, Saunders.

Slide ‹#›

Who would determine which test would be performed and if contrast would be used? (The ordering physician)

Computerized Axial Tomography

X-ray image taken in sections

Computer reconstructs and enhances image

Slide ‹#›

Computerized axial tomography is also known as what? (CAT or CT scan)

The computer reconstructs and enhances the image to produce a three-dimensional construct, which can be used to study the internal structure.

Magnetic Resonance Imaging

Uses magnetic fields to produce an image displayed on computer screen

Codes of same area (e.g., spine) divided on whether or not contrast material used

Slide ‹#›

What does MRI stand for? (Magnetic Resonance Imaging)

The codes are found throughout the Diagnostic Radiology subsection under the body area that the MRI is being performed on.

Angiography (1 of 3)

Used to view vessel obstructions

Dye injected into vessel

Slide ‹#›

In angiography, a dye is injected into the vessels to add contrast, enabling visualization of the vessels.

The dye is used to identify abnormalities inside vessels.

Angiography (2 of 3)

Angiography of aortic arch and brachiocephalic vessels

Figure 24.13

From Stimac GK: Introduction to Diagnostic Imaging, Philadelphia, WB Saunders, 1992, p 447.

Slide ‹#›

See Fig. 24.13 (p. 637).

Here you can see clearly the arch of the aorta (bend) and the brachiocephalic vessels that come off of the aortic arch.

What might the physician be looking for here? (Aortic aneurysm)

Angiography (3 of 3)

Radiologist uses angiography to diagnose vascular conditions

Examples:

Malformations

Strokes

Myocardial infarctions

Slide ‹#›

Angiography is used to identify abnormalities inside the vessels as well as vascular conditions.

Remember

If fewer than total number of views specified in code provided:

Use modifier -52, Reduced Service

Slide ‹#›

If fewer than the total number of views specified in the code for a diagnostic radiology procedure are taken, the modifier -52 should be used, unless a code for the smaller number of views exists.

Diagnostic Ultrasound (1 of 2)

Uses high-frequency sound waves to image anatomic structures

Audible sound waves bounce off body tissues and then are recorded to give information about anatomy of an internal organ

Slide ‹#›

The second subsection is Diagnostic Ultrasound.

What codes are used with these procedures? (76506-76999)

Diagnostic ultrasound uses high-frequency sound waves to image anatomical structure and to detect the causes of illness and disease.

Diagnostic Ultrasound (2 of 2)

Ultrasound showing a gallstone

Figure 24.14

From Goldman L, Schafer AI, editors: Goldman’s Cecil Medicine, ed 24, Philadelphia, 2012, Saunders.

Slide ‹#›

See Fig. 24.14 (p. 639).

This shows an illustration of how ultrasound aids in the diagnosis of disease.

Notice that the gallstones, which are very hard (hence the word “stone”) show up as a shadowing that tells the physician that something is there that doesn’t belong.

Subheadings

Subheadings of Diagnostic Ultrasound primarily based on anatomy

Example:

Head and Neck

Chest

Pelvis

Many notes in subsection directing correct assignment

Slide ‹#›

Ultrasounds are divided on the basis of anatomic location as is the Diagnostic Radiology subsection.

The ultrasounds of the pelvis are further divided if they are obstetrical or nonobstetrical.

Three Locations for Ultrasound Services

76506-76999: Radiology codes for diagnostic ultrasound services

93880-93998: Medicine codes for vascular studies

93303-93355: Medicine codes for echocardiography

Slide ‹#›

Codes for ultrasound services can be found in these three locations in the CPT manual.

Interventional Radiologist

Combination radiologist and surgeon

Provides total procedure for cystography with contrast

Report 74430, X-ray portion and

51600 for injection procedure

Plus code for supply of contrast material (e.g., 99070 or HCPCS code)

Slide ‹#›

An interventional radiologist is a specialist who is skilled in both the surgical procedure and the radiology portion of an interventional radiologic service.

These services require that both a surgery code and a radiology code be used.

Ultrasound Modes and Scans

A-mode or A-scan technology— one-dimensional

M-mode—one-dimensional measurement procedure with movement of trace to allow amplitude and velocity of moving echo-producing structures

B-scan technology—two-dimensional

Real-time scan

A & B scan may be performed together (medical necessity documented)

Slide ‹#›

These four types of ultrasound are listed in the CPT manual.

Understanding these definitions is very important.

The physician’s note must specifically state what type of ultrasound was performed.

A-Mode

A = Amplitude

Technique used to map structure outline

Displays one-dimensional image

Slide ‹#›

A-mode is a one-dimensional display that shows the time it takes the sound wave to reach a structure and reflect back.

What does “A” stand for? (The amplitude of sound return or echo)

M-Mode

M = Motion

Technique used to display movement of structure

Displays one-dimensional image

Slide ‹#›

M-mode is a one-dimensional display of the movement of structures.

What does “M” stand for? (Motion)

B-Scan

B = Brightness

Technique used to display movement of tissues and organs

Known as gray scale ultrasound

Displays two-dimensional image

Slide ‹#›

A B-scan is a two-dimensional display of the structure and the motion of tissues and organs.

What does “B” stand for? (Brightness)

The sound waves bounce off of structures and are projected onto a black-and-white television screen.

Why is a B-scan known as a gray scale ultrasound? (The strong signals display as black, and the weak signals display as lighter shades of gray.)

Real-Time Scan

Technique used to display both structure and motion with time of organ and tissues

Displays two-dimensional image

Slide ‹#›

A real-time scan is a two-dimensional display of the structure and the motion of tissues and organs.

Extent of Study (1 of 2)

Codes often divided on extent of study

Example: Extent of scan as follows

Slide ‹#›

Code to the furthest extent of the study being performed.

What would happen if you did not code to the furthest extent of the procedure performed? (There would be lost revenue.)

Extent of Study (2 of 2)

Complete: Scans entire body

Limited: Scans part of body, i.e., one organ

Follow-up/repeat: Limited study of part of body that was scanned previously

Slide ‹#›

What does “complete” mean? (That the entire body was scanned)

What does “limited” indicate? (That only part of the body was scanned)

What does “follow-up/repeat” indicate? (That a limited study of part of the body was scanned previously)

Radiologic Guidance, Breast, Mammography, Bone/Joint Studies, and Radiation Oncology

Radiologic Guidance (77001-77022)

Fluoroscopic, computed tomography, magnetic resonance imaging guidance, and other

Breast, Mammography (77046-77063)

Such as screening, and computer-aided detection

Bone/Joint Studies (77071-77086)

Such as bone density and joint survey

Radiation Oncology (77261-77799)

Therapeutic use of radiation

Codes for both professional and technical services

Subheading divided based on treatment

Slide ‹#›

What codes are used to report the Radiation Oncology subsection? (77261-77799)

Radiation Oncology involves the therapeutic use of radiation to destroy tumors.

In this subsection, special attention must be given to reporting the professional and technical components.

Radiation Oncology

Initial consultation, prior to decision to treat, reported with E/M Consultation code

Outpatient: 99241-99245

Inpatient: 99251-99255

Follow consultation criteria: Document who and why

Slide ‹#›

The service codes within this subheading include codes that can be used in management of the patient from the initial consultation throughout the course of treatment.

The initial consultation is reported with a code from the E/M (Evaluation/Management) section, whether inpatient or outpatient.

Clinical Treatment Planning—Professional Component

Includes:

Interpretation of special testing

Tumor localization

Determination of treatment volume

Slide ‹#›

Which codes are used to report clinical treatment planning? (77261-77263)

Clinical treatment planning reflects professional services provided by the physician.

Clinical Treatment Planning (1 of 2)

Choice of treatment method

Determination of number of treatment ports

Selection of treatment devices

Other necessary procedures

Slide ‹#›

Clinical treatment planning includes interpretation of tumor localization, treatment volume determination, dosage determination, number of ports, and the number of treatment devices that will be used.

This code covers the physician planning how to best treat this patient for this cancer.

Clinical Treatment Planning (2 of 2)

Clinical Treatment Planning consists of

Three types of treatment plans

For all patients requiring radiation therapy

Slide ‹#›

How is simulation different from treatment planning? (Simulation is the examination performed [sometimes done with aid of CT scanner] for the physician to view a closer look at the tumor, and from this simulation he or she is able to come up with the treatment plan.)

Levels of Planning (77261-77263) (1 of 2)

Simple: One treatment area, one port or one set of parallel ports

Intermediate: Three or more ports, two separate treatment areas, multiple blocking

Slide ‹#›

Plans are set up for all patients who require radiation therapy.

There are three levels of planning: simple, intermediate, and complex.

Simple is a single treatment area or single treatment port.

Intermediate is three or more converging ports or two separate treatment areas.

Levels of Planning (77261-77263) (2 of 2)

Complex: Complex blocking, custom shielding blocks, tangential ports, special wedges, or compensators, three or more treatment areas, special beams

Unlisted procedure (77299)

Slide ‹#›

Complex is the most labor intensive of the planning levels.

The level of treatment planning is determined by the physician.

Simulation (77280-77299)

Determines placement of treatment areas/ports for radiation treatment

Does not include administration of radiation

Slide ‹#›

Which codes are used to report simulation? (77280-77299)

Simulation involves identification of treatment areas and appropriate placement of ports for radiation treatment.

Four Levels of Simulation

Simple: One treatment area with one port or pair of ports

Intermediate: Three or more ports, two separate treatment areas, multiple blocking

Complex: Tangential ports, three or more treatment areas, complex blocking

3D: Computer generated three-dimensional image of tumor

Slide ‹#›

As with clinical treatment planning, there are three basic levels of simulation: simple, intermediate, and complex.

A fourth level of simulation involves the study of three-dimensional, computer-generated reconstruction of tumor volume and surrounding critical normal tissue structures on the basis of direct CT scan and/or MRI data in preparation for therapy.

Medical Radiation Physics, Dosimetry, Treatment Devices, and Special Services (77295, 77300-77370)

Decision-making services of physicians

Treatment types

Dose calculation and placement (dosimetry)

Development of treatment device

Stereotactic Radiation Treatment Delivery (77371-77373)

Pay close attention to notes

Delivers large dose to specific tumor site

Slide ‹#›

Which codes are used to report Medical Radiation, Physics, Dosimetry, Treatment Devices, and Special Services? (77295, 77300-77370)

Is it common to have several dosimetry or device changes during a treatment course? (Yes)

What is dosimetry? (The calculation of radiation dose and placement)

Codes in this subheading are most often divided on the basis of the level of treatment (simple, intermediate, complex).

77371-77373 fall under stereotactic radiation treatment delivery. Pay close attention to the notes for instructions on c

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