Chapter 17 Radiology CPC

radiology

a branch of medicine using radiation-including ionizing radiation, radionucleotides, nuclear magnetic resonance, and ultrasound to diagnose & treat disease

computerized axial tomography (CAT or CT scan)

an imaging technique used to study the brain to pinpoint injuries and brain deterioration

MRI (magnetic resonance imaging)

a technique that uses magnetic fields and radio waves to produce computer-generated images that distinguish among different types of soft tissue; allows us to see structures within the brain

ultrasound imaging

technique for using high-pitched sound waves to form an image of the fetus in the womb or to view an image of an organ or abnormality

radiation oncology

radiation therapy for tumors

Positron Emission Tomography (PET)

a method of brain imaging that assesses metabolic activity by using a radioactive substance injected into the bloodstream

Radiology Technician or Radiologist

places the patient in the correct position and then adjusts the equipment to the correct angle, height, and settings

Planes

an imaginary line that divides the body or an organ into sections

frontal (coronal) plane

cuts the body into front (anterior) & back (posterior) halves

sagittal plane

cuts body into left and right portions

transverse plane (horizontal plane) (axial plane)

cuts the body into upper (superior) and lower (inferior) halves

midsagittal plane

divides the body into equal right and left sides

anatomic position

erect, facing forward, arms rotated outward with the palms forward, hands open with thumbs pointed out. The feet are together or slightly apart.

supine position

lying down on the back with the face up. this position is also known as dorsal recumbent (lying down)

prone position

lying face down on the front of the body. This position is also known as ventral recumbent.

lateral position

position in which the side of the subject is next to the film. this can be performed as erect lateral (standing side) or lateral decubitis (lying down side)

oblique position

Slanted position where the patient is lying at an angle neither prone nor supine. In radiology, you may see right anterior oblique (RAO), left anterior oblique (LAO), right posterior oblique (RPO), or left posterior oblique (LPO). the anterior or posterior terminology indicates the part of the body closer to the film. For example, in RAO, a person is on his right side, with the anterior part of the body closer to the film.

radiological projections refer to what?

refer to the path in which the x-ray beam flows through the body

anteroposterior (AP)

the x-ray beam enters the front of the body (anterior) and exits the back of the body (posterior)

posteroanterior (PA)

the x-ray beam enters the back of the body (posterior) and exits the front of the body (anterior)

lateral

the x-ray beam enters one side of the body and exits the other side. lateral projections are named by the side of the body placed next to the film.

oblique

the x-ray beam enters at an angle that is neither frontal (AP) nor lateral (PA)

each procedure ordered and performed must be validated by what?

medical necessity

what supports medical necessity?

diagnostic coding

in order to establish medical necessity, diagnoses must reflect what?

a sign, symptom, condition, or injury

Routine Services

Usually provided as part of basic services

Usually built into overhead or operating costs

screening examination

there are no signs or symptoms, but the provider is looking for a specific disease or illness ex. mammogram

Sign or Symptom

if radiological service is for a sign or symptom and that is the only diagnosis documented, report the sign or symptom as the diagnosis for the radiological service

What should you code if a radiological examination is ordered with a rule out diagnosis?

ask the provider to obtain the sign or symptom for the ordered test

What should you code if a sign or symptom is the only diagnosis documented?

report the sign or symptom as the diagnosis for the radiological service

What should you code for patients receiving diagnostic services only during an encounter or visit?

Sequence first the diagnosis, condition, problem, or other reason for encounter/visit shown in the medical record to be chiefly responsible for the outpatient services provided during the encounter/ visit (codes for other diagnoses (like chronic conditions) may be sequenced as additional diagnoses

general adult medical examination without abnormal findings icd 10 code

Z00.00

general adult medical examination with abnormal findings icd 10 code

Z00.01

mammography screening icd 10 code

Z12.31

X-Ray performed as part of preoperative examination

Use codes Z01.810-Z01.818

what should you code if routine testing is performed during the same encounter as a test to evaluate a sign, symptom, or diagnosis?

assign both the Z code and the code describing the reason for the non-routine test

encounter for other specified special examination icd 10 code

Z01.89

what icd 10 code should be reported if a patient has a mammography for breast pain, but the results are normal?

since the results came back normal, you would code the sign or symptom for the test, which is N64.4, mastodynia. If it came back abnormal you would report the diagnosis.

can rule out conditions be assigned as diagnosis codes?

no, they cannot. if a diagnosis is not definite, code the symptoms

Coding Open vs. Closed Fractures

Unless a fracture is specified as open assume the fracture is closed (default).

incidental findings

potential disorders uncovered while looking for something else & they should never be listed as the primary diagnosis, but may be listed as the secondary diagnosis

how can orders from the treating practitioner be documented?

1. A written document signed by the treating physician/ practitioner, which is hand-delivered, mailed, or faxed to the testing facility

2. A telephone call by the treating physician/ practitioner, or his or her office, to the testing facility

3. An electronic mail (email) by the treating physician/ practitioner, or his or her office, to the testing facility

once the written interpretation is dictated& transcribed, what cannot happen?

there can be no alterations to the report for billing or coding purposes

what must accompany every unlisted cpt code?

a special report describing the procedure and the reason the procedure was medically necessary & an explanation of the equipment, time, and effort involved

where can radiological procedures be performed?

on any part of the body

Stand-alone services

only one procedure is performed, such as a chest x-ray or an ankle x-ray

Additional Services

services that are performed in conjunction with other services, such as MRI guidance for needle placement during a biopsy

Separate procedures

Should be coded only if performed alone or with an unrelated service (there are very few separate procedures in radiology section)

Unlisted procedure

radiological services not covered by a specific CPT code, many unlisted procedure codes end in 99 in radiology section, but some end in 96, 97, or 98

supervision and interpretation

S&I codes describe the supervision and interpretation of a radiological procedure. Interventional radiologic procedures are used to diagnose and treat conditions using invasive procedures.

examples of common procedures containing a supervision & interpretation component include what?

vascular procedures performed on veins & arteries

supervision & interpretation coding

when a procedure requires radiological guidance, a code from the surgery or medicine section is reported along with the supervision and interpretation code from the radiology section

the radiologist billing the supervision & interpretation must be present when?

at the time of the procedure and provide a written report

contrast material

a substance or material that lights up the structure being studied so it can be visualized

how can contrast material be administered?

1. intravascularly

2. intra-articularly

3. intrathecally

Intravascular administration

using a vein or artery

intra-articular administration

in a joint

intrathecal administration

within a sheath, or within the subarachnoid or cerebral spinal fluid

oral contrast

barium or a mixture of fruit juice & iodine-containing liquid

when contrast is given orally or rectally, is it appropriate to report a "with contrast" code?

no, it is not appropriate

Gadolinium

a contrast agent used in MRI

Iodine

a contrast agent used for intravenous pyelograms (IVP), CT scans, arthrograms, and angiograms

what happens if the patient is allergic to shellfish?

since shellfish is high in iodine, a nonionic contrast substitute is infused to lessen or prevent a potential allergic reaction

can MRIs or CT scans be reported with and without contrast?

yes, they may be performed with contrast, without contrast, and without contrast followed by with contrast

Coding Radiologic Service with Contrast

Typically there is an additional code for the contrast. A HCPCS level II code should be added to identify the substance used (if it is not specified in the CPT code).

Contrast material is not included as part of the radiologic service code and must be reported separately.

radiologist's written report

documentation for the professional component of the radiological procedure, and must be signed

Types of Radiological Services

-diagnostic radiology

-diagnostic ultrasound

-radiological guidance

-breast, mammography

-bone/ joint studies

-radiation oncology

-nuclear medicine

diagnostic radiology (diagnostic imaging) cpt codes

70010-76499

diagnostic ultrasound cpt codes

76506-76999

radiologic guidance cpt codes

77001-77022

breast, mammography cpt codes

77053-77067

bone/joint studies cpt codes

77071-77086

radiation oncology cpt codes

77261-77799

nuclear medicine cpt codes

78012-79999

scout film

plain-film x-ray image obtained to detect any obvious pathology before further imaging, not coded separately because they are part of the basic procedure

screening film

may be used to pre-diagnose or confirm a suspected condition

comparison film

may be used to pinpoint an abnormality or deformity between a normal and injured body part. Unless there is an injury in both areas, only X-rays taken of the affected area are coded.If

diagnostic film

may be required to evaluate the extent of the presenting symptoms or conditions or to track the progression of the patient's condition or illness

periodic films

may be required to determine healing of the bone or maintenance of accurate alignment if splinting or casting is applied to the fracture

spot films

submitted for a radiologist's interpretation when another physician performs radiology supervision & interpretation procedure

If the radiologist was not present during the performance of the radiological procedure

Use modifier 52 to report reduced services

Imaging Errors

Films that are unreadable, improperly positioned, or underdeveloped are considered operator error and should not be coded. The patient should not be penalized for an error.

low intensity imaging x-ray device

lightweight portable handheld instrument using a low level isotope as its penetrating energy source

diagnostic radiology consists of what?

-x-rays

-MRI

-CT scan studies

plain x-ray

taking a snapshot or picture of inside of the body, focuses x-ray energy on a body part creating an image of solid or dense internal structure

bone appears what color in an x ray?

white

contrast material appears what color in an x ray?

white

structures containing air, such as lungs, appear what color on an x ray?

black

muscle, fat, and fluid appear what color?

shades of gray

CT scans

use a series of x-rays to produce cross-sectional pictures of the body

CT scans are commonly used to diagnose what?

tumors, internal injuries related to trauma, vascular disease

computerized angiography (CTA)

CT scan of the blood vessels

magentic resonance imaging (MRI)

produces slices of images by using a magnetic field and the protons within the body, slices can be combined to produce 3-D images that may be viewed from different angles. this precise imaging helps physicians differentiate between healthy & unhealthy tissue

Multiplanar diagnostic imaging (MPDI)

Multiplanar diagnostic imaging (MPDI) combines data produced by CT scanning to create reconstructed oblique images that may contribute further diagnostic information. MPDI is also known as planar image reconstruction or reformatted imaging.

Coding Radiographic Arthrography

If radiographic arthrography is performed, use the arthrography supervision and interpretation code for the appropriate joint. Fluoroscopy is included in these codes. If CT or MRI is performed without radiographic arthrography, use the appropriate joint injection code, the accurate CT or an MRI code, and the correct imaging guidance code for needle placement for contrast injection. When an intrathecal injection is required, report 61055 or 62284.

MRIs are used for doing differential diagnosis of what?

mediastinal & retroperitoneal masses, including abnormalities of the large vessels such as aneurysms and dissection of vessels, neoplasia, parenchymas. Can detect and stage pelvic and retroperitoneal neoplasms. Can detect pericardial thickening. Can also detect primary and secondary bone neoplasm and aseptic necrosis. Can be used to detect early signs of bone infection in patients with metallic prostheses.

parenchyma

functional tissues of any organ, such as the tissues of the bronchioles, alveoli, ducts, and sacs, that perform respiration

magnetic resonance angiography (MRA)

procedure used to examine blood vessels, provides images of normal & diseased blood vessels, as well as visualization and quantification of blood flow through these vessels

Phase contrast (PC)

Measures the difference between the phases of proton spins in tissue and blood and measures both the venous and arterial blood flow at any point in the cardiac cycle.

time of flight (TOF)

measures the difference between the amount of magnetization of tissue & blood & provides information on the structure of blood vessels, indicating blood flow. Can be used to produce 3D images.