Chapter 16 CPT Radiology

Radiology Subsections The following subsections are further divided into anatomic categories: Diagnostic radiology imaging Diagnostic ultrasound Radiation oncology Nuclear medicine

Diagnostic Imaging Subsection Includes: Noninvasive diagnostic and therapeutic procedures Invasive diagnostic and therapeutic procedures Computerized tomography (CT) Magnetic resonance imaging (MRI)

Planes of View Coronal (frontal) Midsagittal Sagittal Transverse (horizontal, axial) (continued)

Planes of View Planes that separate body structures (midsagittal, sagittal, coronal, and transverse)

Radiographic Projections Anteroposterior projection Lateral projection (side view) Oblique projection Posteroanterior (PA)

Radiographic Projections

Radiology Procedures Angiography Aortography Arthrography Computed axial tomography (CT, CAT) Computed tomography angiography (CTA) (continued)

Radiology Procedures Nuclear imaging Positron emission tomography (PET) Single photon emission computerized tomography (SPECT) Ultrasound (ultrasonography) Venography X-ray

Radiology Procedures Cystography Fluoroscopy MRI

Contrast Medium Injection Device

Lateral Chest X-Ray Bones of the spine are white; soft tissues are shades of gray

Abdominal CT Scan Liver is predominant in upper-left; stomach is visible in upper-right

Fluoroscopy Unit Dynamic radiographic examination that allows for visualization of flow of barium through gastrointestinal tract, injection of a contrast agent into the heart, etc. Courtesy of GE Healthcare.

Computed Tomography Sections

3D Computed Tomography Angiography Reconstructions Carotid arteries (continued)

3D Computed Tomography Angiography Reconstructions Coronary arteries

MRI Includes stationary magnet, radio frequency coil, and gradient coils

MRI of the Brain Courtesy of GE Healthcare

Key Terms Roentgen (R, r) Radiation absorbed dose (rad) Gray (gy) Roentgen-equivalent-man (rem)

Radiology Procedures Three components: Modifiers: Technical component Professional component Global service Modifiers: -26 (professional component) -TC (technical component)

Coding Tips Modifier -50 (bilateral procedure) is not added to radiology procedures that are performed bilaterally because code descriptions often specify “bilateral.” Modifier -51 (multiple procedures) is not usually added to radiology codes. HCPCS level II anatomical modifiers -Lt and -Rt are added when appropriate.

“Complete” Number of views required for study of a designated body part Do not confuse use in the code description with use in a parenthetical note below a code

E/M Services Provided by Radiologist No code reported when radiologist provides E/M services as part of radiographic procedure

Radiology Section Guidelines Provide instruction about: Subject listings Separate procedures Subsection information Unlisted service or procedure Special report Supervision and interpretation Administration of contrast material(s) Written report(s)

Radiology Subsections The following Radiology subsections contain notes unique to the subsection: Diagnostic ultrasound Radiation oncology Nuclear medicine

Separate Procedures Some procedures are considered an integral component of a total service or procedure and are identified by the descriptor “separate procedure.”

Special Report When a service is new, unusual, or rarely provided, it requires a special report to validate the medical necessity and appropriateness of the service (e.g., complexity of symptoms).

Component Coding Allows for reporting a radiology procedure code and a surgical procedure code to completely describe the service provided

Radiology Coding To accurately code diagnostic radiology procedures, identify: Anatomic site Type of procedure Number of views Laterality of procedure Use of contrast media

Vascular Procedures Selective vascular catheterization Nonselective vascular catheterization

Coding Tip Report a separate code when a diagnostic angiography or venography is performed during a separate session (from the interventional procedure).

Ultrasound Display Modes A-mode (amplitude modulation) B-scan (brightness mode, gray-scale ultrasound) M-mode (motion mode) Real-time scan

Ultrasound Guidance Procedures Report either a diagnostic ultrasound or guidance ultrasound code, but not both for the same patient during the same encounter.

Radiation Oncology Radiation oncology codes include professional services and technical procedures that are organized according to types of treatment provided: Consultation Clinical treatment planning Radiation treatment delivery Neutron beam treatment delivery

Clinical Treatment Planning External sources Internal sources Systemic radiation therapy Stereotactic radiosurgery (SRS) Stereotactic body radiation therapy (SBRT)

Coding Tip Clinical treatment planning is reimbursed: Once per course of radiation therapy Only when performed directly by radiation oncologist

Therapeutic Radiology Treatment Types of planning: Simple Intermediate Complex

Radiation Treatment Delivery Includes ongoing patient evaluation (codes not reported separately) Codes are reported for administration of radiation therapy per treatment

Nuclear Medicine Subsection contains two headings: Therapeutic Diagnostic