Radiology - CPT

A branch of medicine that uses radiant energy to diagnose and treat patients. The term originally referred to the use of x-rays to produce radiographs but now commonly applied to all types of medical imaging.

Fluoroscopy views the inside of the body and projects it onto a television screen. It provides a live image whereby the physician can view the function and structure of an organ, for example, 71034 (Chest x-ray with Glossary fluoroscopy).
is an x-ray procedure that allows the visualization of internal organs in motion. It uses real-time video images. After x-rays pass through the patient, instead of using film, the images are captured by a device called an image intensifier and converted into light. The light is then captured by camera and displayed on a video monitor. Fluoroscopy allows the study of the function of the organ, physiology, as well as the structure of the organ, anatomy.

MRI uses magnetic energy to view the soft tissue structures of the body. Codes such as 72148 (MRI, spinal canal) describe procedures that use magnetic resonance imaging.
Procedure that uses nonionizing radiation to view the body in a cross-sectional view
is a radiology technique that uses magnetism, radio waves, and a computer to produce images of body structures. The MRI scanner is a tube surrounded by a giant circular magnet.

Tomography, or computed tomography (CT), is used to view a single plane of the body. For example, code 70450 documents the use of tomography to view the head or brain on a single plane. The use of tomography for a patient who has right lung carcinoma is illustrated here. There is much greater detail obtained with tomography than with conventional radiography.
Procedure that allows viewing of a single plane of the body by blurring out all but that particular level
is the process of producing a tomogram, a two-dimensional image of a slice or section, through a three-dimensional object. Tomography achieves this result by simply moving an x-ray source in one direction as the s-ray film is moved in the opposite direction. The tomogram is the picture, tomograph is the apparatus, and tomography is the process.

Biometry is the application of statistics to biologic data. The use of biometry aids the radiologist in the diagnosis of patient conditions, for example, the use of ultrasound echography in the diagnosis of conditions of the eye, as described in code 76516.
It is the application of a statistical method to a biologic fact. For example, the application of this science is radiology has resulted in analysis of data, for example, of the effectiveness of radiation used in the treatment of brain tumors-science applied to biology.

are directional body references that mean closest to, proximal or farthest from, distal, the trunk of the body. The term “proximal” describes a part as being closer to the body trunk than another part, and the term “distal” describes a part as being farther away from the body than another part. The knee would be described as being proximal to the ankle and it would also be described as being distal to the thigh or hip.

front to back position, in which the patient has his or front, anterior, closest to the x-ray machine, and the x-ray travels through the patient from the front to the back.

position, the patient has his or her back, posterior, located closest to the machine, and the beam travels through the patient from back to front.

are side positions. When the patient’s right side is closest to the film, it is call right lateral. When the patient’s left side is closest to the film, it is called left lateral.

more commonly refers to the “back” but may be stated to mean “supine”, means lying on the back.

more commoly refers to the “anterior” but may be states as “prone”, means lying on the stomach.

means lying on the side, Away from the midline of the body (to the side)

are recumbent, lying, positions; the x-ray beam is places horizontally.

means lying down. Thus, right lateral recumbent means the patient is lying on the right side, etc.

views refer to those obtained while the body is rotated so it is not in a full anteroposterior or posteroanterior position but somewhat diagonal.

is the position that allows the beam to skim the body part, which produces a profile of the structure of the body.

any projection that allows the beam to pass through the body part lengthwise.

Toward the midline of the body

Toward the head or the upper part of the body; also known as cephalad or cephalic

In front of

In back of

Away from the head or the lower part of the body; also known as caudad or caudal

Uterine cavity and fallopian tubes

Intervertebral joint

Kidneys, renal pelvis, ureters, and bladder

Bile ducts

Joint

Veins and tributaries

Subarachnoid space of the spine

Epididymis

Urinary bladder

Lymphatic vessels and nodes

Radiographic contrast medium

Photoelectric process of radiographs

Application of a statistical method to a biologic fact

This component is sometimes called the physician portion of the service. The professional portion includes the supervision of the technician and the interpretation of the results, including the preparation of a written report.
describes the services of the physician, including the supervision of the taking of the x-ray film and the interpretation with report of the x-ray films.
When only the professional component of the service is provided, modifier -26 is placed after the CPT code. Modifier -26 alerts the third-party payer to the fact that oly the professional component was provided. If, for example, an independent radiology facility takes a complete chest x-ray, 71030, and sends the x-rays to an independent radiologist who reads the x-rays and writes a report of the findings in the x-rays, the coding for the independent radiologist would be the professional component o;y: 71030-26 for complete chest x-ray, four views.

The professional (physician) portion of the service includes the following:
•Review of the port films
•Review of dosimetry, dose delivery, treatment parameters
•Treatment setup
•Patient examination for medical evaluation and management

This component is the technologist’s service and the equipment, film, and supplies necessary to perform the service.
describes the services of the technologist, as well as the use of the equipment, film, and other supplies. There is no CPT modifier to indicate the technical component of radiologic services. The modifier most commonly used is the HCPCS Level II Modifier -TC, which reports the technical component. When submitting claims for radiologic services in which only the technical component was provided, use a code followed by -TC. For example, if you were the coder for independent radiology facility that took the chest x-ray, 7100, but sent it elsewhere to be interpreted, you would report the technical component only: 71030-TC complete chest x-ray, four views.

This describes a procedure in which both the professional and technical portions of the radiology service are provided.

Component Coding Example
•Professional component: 71030-26 (Supervision and final report)
•Technical component: 71030-TC (Technician, supplies and equipment)
•Global procedure: 71030 (Supervision with final report, technical, supplies and equipment)

Third-party payers usually reimburse radiology services as follows:

•40% for professional component
•60% for technical component
•100% for global procedure

is radiopaque and is placed into the body to improve the view. Radiopaque areas appear light or white on the x-ray film because x-rays cannot pass through the contrast material.
is radiopaque and is placed into the body to improve the view. Radiopaque areas appear light or white on the x-ray film because x-rays cannot pass through the contrast material.
Using the Radiology Guidelines, locate the heading Administration of Contrast Material(s) to complete the following: oral and/or rectal contrast administration alone does not qualify as a study “with contrast”

The injection procedure is bundled into the x-ray procedures that state with contrast unless the guidelines state that a surgical code should also be listed to report the injection procedure.

one-dimensional display reflecting the time it takes the sound wave to reach a structure and reflect back. This process maps the outline of the structure. “A” is for amplitude of sound return, echo.

one-dimensional display of the movement of structures. “M” stands for motion.

two-dimensional display of the movement of tissues and organs. “B” stands for brightness. The sound waves bounce off tissue or organs and are projected onto a black and white television screen. The strong signals display as black and the weaker signals display as lighter shades of gray. B-scan is also called gray-scale ultrasound.

two-dimensional display of both the structure and the motion of tissues and organs that indicates the size, shape and movement of the tissue or organ.

is the use of sound that can be transmitted only through solids or liquids and is a specific version of ultrasonography or ultrasound.

Diagnostic Radiology
•Diagnostic Ultrasound
•Radiologic Guidance
•Breast Mammography
•Bone/Joint Studies
•Radiation Oncology
•Nuclear Medicine

76506-76886: Radiology codes for diagnostic ultrasound services. Ultrasonic guidance codes are in the range 76930-76999.
•93880-93990: Medicine codes for vascular studies.
•93303-93352: Medicine codes for echocardiography.

is the placement of the radioactive material into or around the site of the tumor. The placement can be intracavitary (within the body) or interstitial (within the tissue).

The source is a container of a radioactive element that can be inserted directly into the body where it delivers the radiation dose over time. Examples of sources are seeds, ribbons, and capsules. The ribbons are seeds embedded in tape, the tape is cut to the desired length to control the amount of radiation, and the ribbon is temporarily inserted into the tissue.

The codes in the Clinical Brachytherapy subsection are divided based on the number of sources or ribbons applied:

•Simple: 1 to 4
•Intermediate: 5 to 10
•Complex: 11 or more
Brachytherapy for prostate cancer

CPT code: 76819-26, “>76819 – 26
ICD-9-CM code: 642.93
ICD-10-CM code: O16.3

Hint: In the CPT index, locate fetal testing, ultrasound, biophysical profile, 76819. Modifier -26 is appended to report the professional component. In the ICD-9-CM index, see the Hypertension table and locate the subterms complicating pregnancy, unspecified, 642.93. The fifth digit “3” indicates antepartum condition or complication. In the ICD-10-CM index, locate the main term Hypertension and subterms complicating, pregnancy, O16.3. The fourth character “3” indicates third trimester. Note: 1st trimester is from the last menstrual period (LMP) to week 12; 2nd trimester is from weeks 13 to 27; 3rd trimester is from weeks 28 to the estimated delivery date (EDD).

CPT code: 73610-LT-26,73610-26-LT,73610 – LT – 26,73610 – 26 – LT
ICD-9-CM code: 094.0, 713.5
ICD-10-CM code: M14.672
Hint: In the CPT index, locate x-ray, ankle, 73610. The radiology code indicates a three-view x-ray examination of the ankle. Modifier -LT is appended to identify that the examination was of the left ankle. Modifier -26 is appended to indicate the professional component of the procedure. In the ICD-9-CM index, locate the main term Charcot’s and subterm joint, 094.0. The code description for 094.0 instructs you to use additional code to identify the manifestation, neurogenic arthropathy [Charcot’s joint disease], 713.5. In the ICD-10-CM index, locate the main term Arthropathy and subterms neuropathic (Charcot), ankle, M14.672. The sixth character “2” indicates left ankle.

Most standard radiographic procedures are within this subsection. Codes are often divided based on whether or not contrast material was used. Codes are further based on the number of views (pictures) taken.

Diagnostic radiology is used to diagnose a disease, to monitor a disease process (progression or remission), and for therapeutic procedures. Diagnostic procedures include the following:

•X-ray
•Computerized axial tomography (CAT or CT scan)
•Magnetic Resonance Imaging (MRI)
•Angiography
If fewer than the total number of views specified in the code were provided, use modifier -52, Reduced Service

Diagnostic Glossaryultrasound uses high-frequency sound waves to image anatomic structures. As illustrated here (shown in your text as Fig. 28-14), ultrasound of the gallbladder shows shadowing of a gallstone. There are nine subheadings in Diagnostic Ultrasound that are based primarily on anatomy

Now, let’s consider the location of the Diagnostic Ultrasound codes. The ultrasound codes are often divided based on extent. For example, was the scan a complete scan (entire body), limited scan (part of the body, e.g., one organ), or a follow-up or repeat (limited study of part of the body, previously scanned)?
There are three locations for ultrasound service codes:
•76506-76886: Radiology codes for diagnostic ultrasound services. Ultrasonic guidance codes are in the range 76930-76999.
•93880-93990: Medicine codes for vascular studies.
•93303-93352: Medicine codes for echocardiography.

Radiologic Guidance Subsection (77001-77032).
Guidance.
•Fluoroscopic
•Computed tomography
•Magnetic resonance
•Other
Breast, Mammography Subsection (77051-77059).
Example: Computer-aided detection and screening

Bone/Joint Studies Subsection (77071-77084).
Example: Bone density, bone mineral density, and joint survey

Radiation oncology is the therapeutic use of radiation that involves both professional and technical services. The subsection is divided into subheadings based on the treatment. The initial consultation, prior to the decision to treat, is reported with an E/M consultation code. For the initial inpatient, report codes 99251-99255 and or the outpatient, report codes 99241-99245.

Clinical Treatment Planning is the professional component and includes the following:
•Interpretation of special testing
•Tumor localization
•Determination of treatment volume of radiation
•Choice of treatment method
•Determination of number of treatment ports (locations in which the radiation is placed)
•Selection of treatment devices
•Other necessary procedures used for the treatment
Clinical Treatment Planning consists of planning a simulation.

The Medical Radiation, Physics, Dosimetry, Treatment Devices, and Special Service subheading is an important subheading within the Radiation Oncology subsection.

The codes in this subheading represent the decision-making services of the physician regarding the type of treatment, dose calculation and placement (dosimetry), and development of the treatment device(s).

Radiation Treatment Delivery category codes are used to report the actual delivery of the radiation. The information you need to correctly code the delivery of the radiation treatment is:

•Amount of radiation delivered
•Number of areas treated (single, two, three, or more)
•Number of ports involved (single, three or more, or tangential)
•Number of blocks used (none, multiple, custom)

Radiation Treatment Management codes reflect the reporting of the professional component.
The professional (physician) portion of the service includes the following:

•Review of the port films
•Review of dosimetry, dose delivery, treatment parameters
•Treatment setup
•Patient examination for medical evaluation and management

Nuclear Medicine is the last subsection within the Radiology section.
Nuclear Medicine involves the placement of radioactive material into the body and the subsequent measurement of the emissions from that material. This technique is used both for diagnosis and treatment.
The codes are divided primarily based on organ system, such as endocrine system, gastrointestinal system, and cardiovascular system. The last subheading, Therapeutic, contains the radiopharmaceutical therapies and is divided based on the type of treatment (such as intracavitary or interstitial) and the reason for treatment (such as leukemia, hyperthyroidism). The codes do not include the material injected (radionuclides). Report the radionuclides with therapeutic codes such as 79101 (intravenous), 79200 (intracavity), or 79300 (interstitial), etc. or Level II HCPCS code.

Each year there are numerous changes within the Radiology section to reflect the many advances in the use of radiation in the diagnosis and treatment services.

Keep this in mind so that your knowledge of coding within this section is current.