1. Radiology Coding 101

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

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

4. 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.

5. 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.

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

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

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

9. 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.

10. 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

11. 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

12. 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)

13. 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

14. 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.

15. 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

16. 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

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

18. 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)

19. THE IMPACT OF CODING
Compliance
Reimbursement
Communication