Radiology Coding 101

Jennifer Bash, RHIA, CIRCC, RCC, CPC Director of Coding Education

OBJECTIVES Radiology Basics Anatomy & Terminology Radiology Report Modality Basics General Coding Basics Q&A

BASICS OF RADIOLOGY What is Radiology? The Radiologist’s Role Interpretation Professional/Technical/Global Billing Radiology is the medical specialty of diagnosing and treating injuries and diseases using medical imaging (radiology) procedures (exams/tests) such as X-rays, computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine, positron emission tomography (PET) and ultrasound. RADIOLOGISTS: MAY BE SUBSPECIALIZED BY MODALITY HIGH VOLUME OF CASES NOT TYPICALLY PATIENT FACING (DX)-POTENTIAL CHALLENGE WITH CONTINUITY AND CLINICAL HISTORY THEREFORE RADIOLOGISTS ARE RELIANT ON GOOD DATA TO MAKE THE MOST ACCURATE INTERPRETATION They interpret and report on the resulting images, recommending treatment and, only when appropriate, additional tests to the patient’s referring physician.

ANATOMY & TERMINOLOGY Angiography Oblique Anterior Posterior Appendicular Proximal Cranial Therapeutic Diagnostic Visceral Distal Lateral These are some general terms that would apply to all modalities. We will get into some add’l terms that are modality specific as we move through the presentation.

ACRONYMS DX MIPS CMS MRI CNS NCCI CT NM E&M QPP ICD-10 RS&I IR US LCD VIR MAC

THE RADIOLOGY REPORT Clinical History Report Title/Header Technique Findings Impression

MODALITIES IN RADIOLOGY Diagnostic X-Ray Breast Imaging Ultrasound CT MRI Nuclear Medicine Interventional Radiology

DIAGNOSTIC X-RAY Common Terms Views vs. Images vs. Films Directional Special views Views vs. Images vs. Films Must document number of views “Complete”, “Series”, “Protocol” This is an image of a chest x-ray Some common terms in diagnostic radiology are related to direction or “PLANE” of the view. E.g., AP, Lateral, Coronal, Oblique Body planes can be found in the front section of the CPT book Images/Films do not equal views: If multiple images of the same view are obtained, it still only counts as one view for coding purposes. If repeat view of the exact same structure/plane are performed at the same encounter for the same reason, this is counted as one view for coding purposes. You should only consider summing the views of two separate X-ray procedures if the same provider performs the services at the same encounter for the same diagnostic reason. If, for example, the encounters are the same, but the radiologist performs a second set of views for a separate diagnostic reason than the first, you may code the column 2 code with modifier 59. Therefore, it is best to always document views in the dictated report.

BREAST IMAGING Mammography Tomosynthesis Breast Ultrasound Breast MRI CAD Laterality This is an image comparing mammography and tomosynthesis. Mammography is essentially low dose x-ray/film of the breast Tomosynthesis is a 3D mammogram; known to be effective in dense breasts Tomosynthesis was considered a new technology a few years but is now becoming more standard. If you are billing for these you need to be aware of any special payer policies. Ultrasound uses sound waves to produce an image and we will talk about that in a little more detail on the next slide. Notes for breast imaging: Patient can refer themselves for a screening mammogram US and mammogram are often both billed Mammo and MRI have code options that include CAD (computer aided detection). MRI codes were updated in 2019 to include CAD when performed. Great resource for breast coding questions is the ACR Breast Imaging FAQs for Medicare

ULTRASOUND Common Terms Limited vs. Complete Nonvisualization Duplex Ultrasound uses sound waves to produce an image. Common terms: A/B mode; grayscale; color flow; transabdominal vs. transvaginal The reason for nonvisualization of an element is required to be documented by the physician (e.g., early gestation or surgical absence) Duplex studies evaluate vascular flow

CT Common Terms CT CTA Contrast 3D Reconstruction Computed tomography (CT) is a diagnostic imaging test used to create detailed images of internal organs, bones, soft tissue and blood vessels. CT images can be reformatted in multiple planes which make it an optimal modality for diagnosing/monitoring cancers Common Terms: Axial; reformatting; CTA; enhanced/unenhanced; contrast names- Technique-looking for body site and contrast administration CTA-CT of vascular structures; requires documentation of a 3D technique When billing globally, name strength and concentration of contrast agent is required 3D Reconstruction: Workstation Concurrent Supervision Add on to CT/MR/IR, would not apply to vascular studies (CTA)

MRI Common Terms MRI MRA Contrast Magnetic resonance imaging (MRI) uses a magnetic field, radio waves and a computer to produce detailed pictures of the body's internal structures; generally a clearer and more detailed image and sometimes considered more effective, depending on the condition being evaluated Technique-looking for body site and any contrast administration Common terms-sequences, magnet; enhanced/unenhanced; contrast names-Gadolinium MRA is MR imaging of vascular structures

NUCLEAR MEDICINE Common Terms Types of Studies PET Radiopharmaceuticals Pharmacologic Intervention Nuclear medicine imaging uses small amounts of radioactive materials called radiotracers that are typically injected into the bloodstream, inhaled or swallowed. The radiotracer travels through the area being examined and gives off energy in the form of gamma rays which are detected by a special camera and a computer to create images of the inside of your body. A PET scan measures important body functions, such as blood flow, oxygen use, and sugar (glucose) metabolism, to help doctors evaluate how well organs and tissues are functioning. Technique-body site, RP, any delay/timing, any pharmaceutical used Common terms-radiopharmaceutical, radiotracer, “labeled”, absorption, In many centers, nuclear medicine images can be superimposed with computed tomography (CT) or magnetic resonance imaging (MRI) to produce special views, a practice known as image fusion or co-registration. These views allow the information from two different exams to be correlated and interpreted on one image, leading to more precise information and accurate diagnoses.

INTERVENTIONAL RADIOLOGY Common Terms Non-Vascular Vascular Diagnostic vs. Therapeutic IR involves radiological image guidance (X-ray fluoroscopy, ultrasound, computed tomography [CT] or magnetic resonance imaging [MRI]) to precisely target diagnosis and therapy. Most IR treatments are minimally invasive alternatives to open and laparoscopic (keyhole) surgery and are done percutaneous Technique-basic description of procedure and any guidance/imaging Common terms…could be an entire seminar! Diagnostic Percutaneous Therapeutic Catheter RS&I

CPT CODING BASICS CPT Book Tips Category I, II, & III CPT codes Unlisted Codes Explore your book-modifier definitions, acroyms, terminology, pictures Parenthetical notes, introductory sections

ICD-10 CODING BASICS Highest Specificity Signs and Symptoms Incidental Findings

CODING RESOURCES Authoritative Guidance Societies When to Use Caution Authoritative-CMS, Payer policy (in writing), AMA, AHA LCD’s, NCCI, CPT Assistant, Clinical Examples in Radiology Societies are great as secondary sources ACR-Coding Source (free!) Consultants-Zhealth (IR), CSI, Panacea Be wary of vendors and forums (know the author/source)

THE IMPACT OF CODING Compliance Reimbursement Communication

jennifer.bash@radadvocate.com