RADIOLOGY AND DIAGNOSTIC IMAGING

Radiology lives in the 70000s

The entire radiology section runs from 70010–79999 and is organized first by body area, then by modality (X-ray, CT, MRI, ultrasound, etc.) within each area.


Body Area Ranges to Know

Range

Body Area

70010–70559

Head & Neck

70553–70559

Brain

71045–71555

Chest

72010–72295

Spine & Pelvis

73000–73725

Upper & Lower Extremities

74000–74340

Abdomen

74710–74775

Pelvis (GYN)

76000–76999

Ultrasound

77000–77799

Radiation Oncology

78000–78999

Nuclear Medicine


Within Each Body Area — Modality Order

Once you're in the right body area, codes are generally arranged in this order:

  1. Plain X-ray (fewest digits of complexity, lowest codes)

  2. CT scan

  3. MRI

  4. Angiography/special procedures


Contrast Logic — Applies to CT and MRI

Every CT and MRI code comes in three flavors:

Suffix pattern

Meaning

Without contrast

No contrast used at all

With contrast

Contrast only

Without followed by with

Both — contrast added after initial scan

On the exam, the operative/radiology report will always tell you whether contrast was used. Never assume!


The Combination Code Rule — High Yield!

When two adjacent body areas are scanned in the same session, CPT often has a single combination code that must be used instead of billing separately. The most tested ones:

Study

W/O contrast

W/ contrast

W/ & W/O

CT Abd + Pelvis

74176

74177

74178

MRI Abd + Pelvis

74182

74183

74184

Billing them separately = unbundling = automatic denial. This is one of the most tested traps on the CPC!


Modifier -26 vs TC vs Global

Situation

Modifier

Physician interprets only, facility owns equipment

-26 (professional component)

Facility bills for equipment/tech only

-TC (technical component)

Physician owns equipment AND interprets

No modifier (global billing)


Quick Index Navigation Tip (For the ebook your process would look something like:

  • Ctrl+F the modality (e.g. "CT" or "MRI") then scan for your body part nearby

  • Ctrl+F the body part (e.g. "knee" or "abdomen") and filter by whether you're in the tabular or index section)

  • Once you find the code range, scan up and down for the contrast variation you need

In your CPT index, look up:

CT scan → then the body part

or

MRI → then the body part

This will point you directly to the right code range much faster than searching by body part first.

| Who does what | Modifier | |---|---|| Radiologist interprets only, hospital owns equipment | -26 | | Hospital bills for equipment/tech only | -TC | | Radiologist owns equipment + interprets | No modifier (global) | (For No modifier, TC, or 26)

Radiology Modifier Cheat Sheet

Scenario

Who Bills

Modifier

Example

Radiologist interprets only, hospital/facility owns equipment

Radiologist

-26

Hospital outpatient imaging center, radiologist reads the scan

Hospital/facility owns equipment, radiologist interprets separately

Hospital/Facility

-TC

Hospital bills for the machine and tech, separate from the radiologist

Radiologist owns equipment AND interprets in their own clinic/practice

Radiologist

None (Global)

Independent radiology clinic, same doc owns and reads

Physician orders AND interprets their own in-office imaging

Physician

None (Global)

Pulmonologist interprets their own in-office chest X-ray

"Is the global service being split between two separate parties?"

  • Yes → Split it: Facility bills -TC, Radiologist bills -26

  • No → Same person does it all → No modifier, global billing

Memory Hook:

  • -26 = "26 letters in the alphabet, A to Z, the radiologist reads A to Z of the report"interpretation

  • -TC = "TC = The Clinic/facility owns the equipment"technical/equipment

  • No modifier = "One person, whole pie, no split"global

If documentation says there are symptoms but uses “screening” you must use diagnostic- otherwise if it is asymptomatic, screening codes are fine.