Radiology
Chapter 24: Radiology
Introduction to Radiology
Radiology: A branch of medicine that uses radiant energy for the diagnosis and treatment of patients.
Specialist in radiology is termed a radiologist (doctor of medicine).
Radiology Subsections
Major Subsections of Radiology
Diagnostic Radiology
Focuses on the aorta and arteries.
Diagnostic Ultrasound
Radiologic Guidance
Breast, Mammography
Bone/Joint Studies
Radiation Oncology
Example: Clinical Brachytherapy
Nuclear Medicine
Key Terms in Radiology
Fluoroscopy
Definition: A technique to obtain real-time moving images of the interior of a body using a fluoroscope.
Function: Operates using a live image projection, allowing physicians to view organ function and structure.
Example: Chest X-ray with fluoroscopy, codes 71047, 76000.
Magnetic Resonance Imaging (MRI)
Overview of MRI
MRI employs magnetic energy to view soft tissue structures.
Example: MRI of lumbar spine canal, coded as 72148.
Magnetic Resonance Angiography (MRA)
Definition: A specific application of MRI for visualizing blood flow and images of normal and diseased blood vessels.
Tomography and CT Scanning
Tomography / CT Scan
Definition: A specialized imaging technique to view a single plane of the body.
Example: Tomographic scan of head or brain, coded as 70450.
Case Study: CT scan of lung carcinoma showing various views like soft tissue and bone detail, showcasing greater detail than conventional radiographs.
Biometry in Radiology
Definition of Biometry
Application of statistical methods to biological facts.
Example: Use of ultrasound echography in the biometry of the eye, coded as 76516.
Anatomical Plane Definitions
Planes of the Body
Median (midsagittal) plane
Coronal (frontal) plane
Transverse (horizontal) plane
Directions:
Cephalic (superior)
Medial
Lateral
Caudal (inferior)
Anterior (ventral)
Posterior (dorsal)
Position and Projection Terminology
Definitions
Position: The way the patient is placed for the examination.
Projection: The path of the X-ray beam as it travels through the body.
Radiology Terminology
A wide variety of terms and abbreviations are used specific to planes, positions, and projections.
Component Coding in Radiology
Three Component Terms
Professional: The physician's role in the service.
Technical: The technologist's services, including equipment and supplies.
Global: A combination of both professional and technical services provided.
Professional Component (-26)
Definition: A component of radiology service pertaining to physician duties, which includes supervision of technicians and interpretation of results with a written report.
Technical Component (-TC)
Definition: Refers to the technologist’s services, encompassing the use of equipment, film, and necessary supplies for the imaging procedure.
Global Procedure
Definition: Refers to when both professional and technical portions of radiology service are provided. No modifiers (-TC or -26) are applied if the facility owns the equipment and employs a radiologist.
Example in Chest X-ray
Professional component: 71048-26 (includes supervision and final report).
Technical component: 71048-TC (includes technician services, supplies, equipment).
Global procedure: 71048 (encompasses both professional and technical).
Reimbursement Codes
Understanding Global Procedure Reimbursement
Third-party payers usually reimburse:
40% for the professional component
60% for the technical component
100% for the global procedure.
Contrast Material in Imaging
Definition
The statement "with contrast" indicates an injection built into the code.
Notes on components specify codes.
Example: 75893 for venous sampling indicates further procedures using code 36500.
Oral or rectal contrast does not meet the criteria for "with contrast."
Overview of Radiology Subsections Revisited
Diagnostic Radiology: Various procedures using imaging to diagnose and monitor diseases.
Diagnostic Ultrasound: Non-invasive imaging utilizing high-frequency sound waves.
Radiologic Guidance, Breast Mammography, Bone/Joint Studies: Specific practices under radiologic guidance.
Radiation Oncology: The therapeutic use of radiation, divided into various coding subcategories.
Nuclear Medicine: A field utilizing radioactive materials for both diagnosis and treatment.
Diagnostic Radiology Procedures
Types of Diagnostic Procedures Include:
X-ray
Computerized Axial Tomography (CAT or CT scan)
Magnetic Resonance Imaging (MRI)
Angiography
Each procedure codes vary depending on the use of contrast materials and number of views taken.
Diagnostic Ultrasound
Diagnostic Ultrasound Overview
Utilizes high-frequency sound waves to image anatomic structures, with technology enabling visualization through sound wave reflection.
Distinct subheadings based on anatomy:
Head and Neck
Chest
Pelvis
Diagnostic ultrasound services are coded under specific radiology codes (76506-76999).
Interventional Radiology
Role of Interventional Radiologist
A hybrid specialization combining radiologist and surgeon roles.
Total procedure, e.g., cystography with contrast requiring multiple codes for reporting.
Ultrasound Modes and Scans
Different Techniques
A-mode (A-scan): One-dimensional mapping technique for outlining structures.
M-mode: One-dimensional display used to measure movement.
B-scan: Two-dimensional imaging (gray scale ultrasound).
Real-time scan: Two-dimensional imaging reflecting both structure and motion over time.
Extent of Study in Imaging
Classifications
Complete: Scans covering entire body.
Limited: Focused scans on a single organ.
Follow-up/repeat: Targeted studies based on previous scans.
Radiologic Guidance and Specialty Practices
Specialty Areas in Radiology
Radiologic Guidance: Various imaging methodologies like fluoroscopic guidance and CT imaging.
Breast Mammography: Codes for routine screenings and specialized detection techniques.
Bone/Joint Studies: Including bone density and joint assessments.
Radiation Oncology: Detailed coding for a range of therapeutic procedures.
Clinical Treatment Planning
Components of Clinical Treatment Planning
Interpretation and planning for effective treatment method selection.
Divided into complex, intermediate, and simple treatment categories based on the scope and required technology.
Simulation Processes in Radiation Therapy
Levels of Simulation
Simple: Basic planning with one port.
Intermediate: For multiple ports or treatment areas.
Complex: Involving custom blocking and special beams.
3D: Utilizing computer-generated imaging to determine accurate tumor placement.
Radiation Treatment Delivery Codes
Specific Codes
Delivery codes range from 77401 to 77525, focusing on various types of radiation like electron or proton environments.
Parameters required for coding include radiation amount, treatment areas, ports involved, and blocks used.
Reporting on Radiation Treatment Management
Professional Service Reporting
Comprehensive review processes ensuring full patient examination and dosimetry reporting.
Clinical Brachytherapy
Definition and Application
Placement of radioactive materials in or around tumor sites for therapeutic purpose, categorized based on the number of sources used (simple, intermediate, complex).
Nuclear Medicine
Overview of Nuclear Medicine
Involves radioactive materials for both diagnostics and treatment, divided by organ systems utilized for therapy and procedures.
Positron Emission Tomography (PET)
Definition and Application
Non-invasive imaging procedure assessing metabolic activity within various organ systems, with specific coding based on anatomical locations available.
Conclusion
Radiology encompasses a broad array of techniques across its subsections, with clear terminologies and coding practices designed to ensure effective diagnosis, treatment, and management of health conditions.