1. 1 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. CHAPTER 11 RADIOLOGY SECTION

2. 2 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Radiology Radiology: Branch of medicine that uses radiant energy to diagnose and treat patientsRadiology: Branch of medicine that uses radiant energy to diagnose and treat patients Specialist in radiology: Radiologist (doctor of medicine)Specialist in radiology: Radiologist (doctor of medicine)

3. 3 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Radiology Subsections Diagnostic RadiologyDiagnostic Radiology –Aorta & arteries Diagnostic UltrasoundDiagnostic Ultrasound Radiologic GuidanceRadiologic Guidance Breast, MammographyBreast, Mammography Bone/Joint StudiesBone/Joint Studies Radiation OncologyRadiation Oncology –Clinical Brachytherapy Nuclear MedicineNuclear Medicine Musculoskeletal SystemMusculoskeletal System Cardiovascular SystemCardiovascular System

4. 4 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Procedures Fluoroscopy views inside of body, projects onto television screenFluoroscopy views inside of body, projects onto television screen Live images by which physician can view function and structure of organLive images by which physician can view function and structure of organ –Example: 71034, Chest x-ray with fluoroscopy

5. 5 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Magnetic Resonance Imaging MRI uses magnetic energy to view soft tissue structuresMRI uses magnetic energy to view soft tissue structures –Example: 72148, MRI of lumbar spine canal –Example: 72148, MRI of lumbar spine canal (Cont’d…)

6. 6 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. MRI (…Cont’d) MRA—Magnetic Resonance Angiography—is application of MRI that provides visualization of blood flow, as well as images of normal and diseased blood vesselsMRA—Magnetic Resonance Angiography—is application of MRI that provides visualization of blood flow, as well as images of normal and diseased blood vessels Figure: 11.12 From Bradley WG, Daroff RB, Fenichel GM, Jankovic J: Neurology in Clinical Practice, ed 5, Philadelphia, 2008, Butterworth-Heinemann.

7. 7 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Tomography or CT Tomography used to view single plane of bodyTomography used to view single plane of body –Example: 70450, Tomographic scan of head or brain (Cont’d…)

8. 8 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. CT Scan of Lung Carcinoma (…Cont’d)

9. 9 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Biometry Biometry: Application of statistical methods to biological factsBiometry: Application of statistical methods to biological facts –Example: 76516, Use of ultrasound echography in biometry of eye Ultrasound diagnostic non-invasive procedures are performed to determine composition and contours of ocular and orbital structuresUltrasound diagnostic non-invasive procedures are performed to determine composition and contours of ocular and orbital structures

10. 10 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Planes of Body Figure: 11.1 Imaginary lines used as points of referenceImaginary lines used as points of reference

11. 11 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Position and Projection Position: Way in which patient placedPosition: Way in which patient placed Projection: Path x-ray beam travelsProjection: Path x-ray beam travels

12. 12 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Terminology Radiology uses a wide variety of terms and abbreviations specific to planes, positions, and projectionsRadiology uses a wide variety of terms and abbreviations specific to planes, positions, and projections

13. 13 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Component Coding Three component termsThree component terms –Professional –Technical –Global—no modifier

14. 14 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Professional Component (- 26) Physician portion of service, includesPhysician portion of service, includes –Supervision of technician –Interpretation of results, including written report From Young AP, Proctor DB: Kinn's The Medical Assistant, ed 10, St. Louis, 2007, Saunders.

15. 15 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Technical Component (-TC) Technologist’s servicesTechnologist’s services Equipment, film, and suppliesEquipment, film, and supplies From Long BW, Frank ED, Ehrlich RA: Radiography Essentials for Limited Practice, ed 2, St. Louis, 2006, Saunders.

16. 16 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Global Procedure Both professional and technical portions of radiology serviceBoth professional and technical portions of radiology service If facility where procedure was performed owns the equipment and has a radiologist on staff who reads the report global serviceIf facility where procedure was performed owns the equipment and has a radiologist on staff who reads the report global service –No -TC, No -26

17. 17 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Component Modifiers If only professional component of radiology service provided append -26 to codeIf only professional component of radiology service provided append -26 to code(Cont’d…)

18. 18 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Component Modifiers (…Cont’d) If only technical component was provided append -TC to codeIf only technical component was provided append -TC to code –-TC: HCPCS modifier used with CPT and HCPCS codes

19. 19 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Global Procedure If both professional and technical components of radiology service provided, use no modifierIf both professional and technical components of radiology service provided, use no modifier(Cont’d…)

20. 20 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. For Example: Chest X-Ray (…Cont’d) Professional component:Professional component: –71030-26 (Supervision and final report) Technical component:Technical component: –71030-TC (Technician, supplies, equipment) Global procedure: 71030 (both professional and technical)Global procedure: 71030 (both professional and technical)(Cont’d…)

21. 21 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Global Procedure (…Cont’d) Third-party payers usually reimburseThird-party payers usually reimburse –40% professional component –60% technical component –100% global procedure

22. 22 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Contrast Material Statement “with contrast” implies injection built into codeStatement “with contrast” implies injection built into code(Cont’d…)

23. 23 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Contrast Material (…Cont’d) Notes indicate codes for componentsNotes indicate codes for components –Example: 75801, Lymphangiography; see 38790 (Injection procedure) Oral or rectal contrast does not qualify for “with contrast”Oral or rectal contrast does not qualify for “with contrast”

24. 24 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Interventional Radiologist Combination radiologist and surgeonCombination radiologist and surgeon Provides total procedure for cystography with contrastProvides total procedure for cystography with contrast –Report 74430, X-ray portion and –51600 for injection procedure, –Plus code for supply of contrast material (e.g., 99070)

25. 25 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Overview of Radiology Subsections Diagnostic RadiologyDiagnostic Radiology Diagnostic UltrasoundDiagnostic Ultrasound Radiologic GuidanceRadiologic Guidance Breast, MammographyBreast, Mammography Bone/Joint StudiesBone/Joint Studies Radiation OncologyRadiation Oncology Nuclear MedicineNuclear Medicine

26. 26 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Diagnostic Radiology “Complete” in a code description in radiology section, means all views taken of specified body site“Complete” in a code description in radiology section, means all views taken of specified body site Most standard radiographic proceduresMost standard radiographic procedures Codes often divided on whether contrast material usedCodes often divided on whether contrast material used Codes further divided on number viewsCodes further divided on number views(Cont’d…)

27. 27 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Diagnostic Radiology (…Cont’d) Used to:Used to: –Diagnose disease –Monitor disease process—progression or remission –Therapeutic procedures and guidance

28. 28 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Diagnostic Procedures Include X-rayX-ray Computerized axial tomography (CAT or CT scan)Computerized axial tomography (CAT or CT scan) Magnetic resonance imaging (MRI)Magnetic resonance imaging (MRI) AngiographyAngiography Subdural hematoma CT of renal artery From Mettler FA: Essentials of Radiology, ed 2, Philadelphia, 2005, Saunders. From Walsh PC, editor: Campbell's Urology, ed 8, Philadelphia, 2002, Saunders.

29. 29 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Computerized Axial Tomography X-ray image taken in sectionsX-ray image taken in sections Computer reconstructs and enhances imageComputer reconstructs and enhances image

30. 30 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Magnetic Resonance Imaging Uses magnetic fields to produce an image displayed on computer screenUses magnetic fields to produce an image displayed on computer screen Codes of same area (e.g., spine) divided on whether or not contrast material usedCodes of same area (e.g., spine) divided on whether or not contrast material used

31. 31 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Angiography Used to view vessel obstructionsUsed to view vessel obstructions Dye injected into vesselDye injected into vessel(Cont’d…)

32. 32 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Angiography (…Cont’d) Angiography of aortic arch and brachio-cephalic vesselsAngiography of aortic arch and brachio-cephalic vessels(Cont’d…) Figure: 11.13 From Stimac GK: Introduction to Diagnostic Imaging, Philadelphia, 1992, WB Saunders.

33. 33 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Angiography (…Cont’d) Radiologist uses angiography to diagnose vascular conditionsRadiologist uses angiography to diagnose vascular conditions Examples:Examples: –Malformations –Strokes –Myocardial infarctions

34. 34 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Remember If fewer than total number of views specified in code provided:If fewer than total number of views specified in code provided: –Use -52, Reduced Service

35. 35 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Diagnostic Ultrasound Uses high-frequency sound waves to image anatomic structuresUses high-frequency sound waves to image anatomic structures Audible sound waves bounce off body tissues and then are recorded to give information about anatomy of an internal organAudible sound waves bounce off body tissues and then are recorded to give information about anatomy of an internal organ(Cont’d…)

36. 36 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Diagnostic Ultrasound (…Cont’d) Ultrasound showing a gallstoneUltrasound showing a gallstone Figure: 11.14 From Goldman L, Ausiello D, eds: Cecil Medicine, ed 23, Philadelphia, 2008, Saunders.

37. 37 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Subheadings Nine subheadings of Diagnostic UltrasoundNine subheadings of Diagnostic Ultrasound Primarily based on anatomyPrimarily based on anatomy

38. 38 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Ultrasound Modes and Scans A-mode or A-scan technology— one-dimensionalA-mode or A-scan technology— one-dimensional M-mode—one-dimensional measurement procedure with movement of trace to allow amplitude and velocity of moving echo- producing structuresM-mode—one-dimensional measurement procedure with movement of trace to allow amplitude and velocity of moving echo- producing structures B-scan technology—two-dimensionalB-scan technology—two-dimensional Real-time scanReal-time scan A & B scan may be appropriately performed together (medical necessity documented)A & B scan may be appropriately performed together (medical necessity documented)

39. 39 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. A-Mode A = AmplitudeA = Amplitude Technique used to map structure outlineTechnique used to map structure outline Displays one-dimensional imageDisplays one-dimensional image

40. 40 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. M-Mode M = MotionM = Motion Technique used to display movement of structureTechnique used to display movement of structure Displays one-dimensional imageDisplays one-dimensional image

41. 41 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. B-Scan B = BrightnessB = Brightness Technique used to display movement of tissues and organsTechnique used to display movement of tissues and organs Known as gray scale ultrasoundKnown as gray scale ultrasound Displays two-dimensional imageDisplays two-dimensional image

42. 42 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Real-Time Scan Technique used to display both structure and motion with time of organ and tissuesTechnique used to display both structure and motion with time of organ and tissues Displays two-dimensional imageDisplays two-dimensional image

43. 43 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Extent of Study Codes often divided on extent of studyCodes often divided on extent of study Example: Extent of scan as followsExample: Extent of scan as follows(Cont’d…)

44. 44 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Extent of Study (…Cont’d) Complete: Scans entire bodyComplete: Scans entire body Limited: Scans part of body, e.g., one organLimited: Scans part of body, e.g., one organ Follow-up/repeat: Limited study of part of body that was scanned previouslyFollow-up/repeat: Limited study of part of body that was scanned previously

45. 45 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Three Locations For Ultrasound Services 76506-76999: Radiology codes for diagnostic ultrasound services76506-76999: Radiology codes for diagnostic ultrasound services 93875-93990: Medicine codes for vascular studies93875-93990: Medicine codes for vascular studies 93303-93350: Medicine codes for echocardiography93303-93350: Medicine codes for echocardiography

46. 46 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Radiologic Guidance, Breast, Mammography, Bone/Joint Studies, and Radiation Oncology Radiologic Guidance (77001-77032)Radiologic Guidance (77001-77032) –Fluoroscopic, computed tomography, magnetic resonance guidance, and other Breast Mammography (77051-77059)Breast Mammography (77051-77059) –Such as screening, and computer-aided detection Bone/Joint Studies (77071-77084)Bone/Joint Studies (77071-77084) –Such as bone density and joint survey Radiation Oncology (77261-77799)Radiation Oncology (77261-77799) –Therapeutic use of radiation –Codes for both professional and technical services –Subheading divided based on treatment

47. 47 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Radiation Oncology Initial consultation, prior to decision to treat, reported with E/M Consultation codeInitial consultation, prior to decision to treat, reported with E/M Consultation code –Outpatient: 99241-99245 –Inpatient: 99251-99255 Follow consultation criteria: Document who and whyFollow consultation criteria: Document who and why

48. 48 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Clinical Treatment Planning— Professional Component Includes:Includes: –Interpretation of special testing –Tumor localization –Determination of treatment volume (Cont’d…)

49. 49 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Clinical Treatment Planning (…Cont’d) Choice of treatment methodChoice of treatment method Determination of number of treatment portsDetermination of number of treatment ports Selection of treatment devicesSelection of treatment devices Other necessary proceduresOther necessary procedures(Cont’d…)

50. 50 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Clinical Treatment Planning (…Cont’d) Clinical Treatment Planning consists ofClinical Treatment Planning consists of –Planning –Simulation

51. 51 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Levels of Planning (77261-77263, 77299) Simple: One treatment area, one port or one set of parallel portsSimple: One treatment area, one port or one set of parallel ports Intermediate: Three or more ports, two separate treatment areas, multiple blocking (Cont’d…)Intermediate: Three or more ports, two separate treatment areas, multiple blocking (Cont’d…)

52. 52 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Levels of Planning (…Cont’d) Complex: Complex blocking, custom shielding blocks, tangential ports, special wedges, three or more treatment areas, special beamsComplex: Complex blocking, custom shielding blocks, tangential ports, special wedges, three or more treatment areas, special beams

53. 53 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Simulation (77280-77295) Determines placement of treatment areas/ports for radiation treatmentDetermines placement of treatment areas/ports for radiation treatment Does not include administration of radiation (Cont’d…)Does not include administration of radiation (Cont’d…)

54. 54 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Four Levels of Simulation (…Cont’d) Simple: One treatment area with one port or pair of portsSimple: One treatment area with one port or pair of ports Intermediate: Three or more ports, two separate treatment areas, multiple blockingIntermediate: Three or more ports, two separate treatment areas, multiple blocking Complex: Tangential ports, three or more treatment areas, complex blockingComplex: Tangential ports, three or more treatment areas, complex blocking 3D: Computer generated 3D image of tumor3D: Computer generated 3D image of tumor

55. 55 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Medical Radiation Physics, Dosimetry, Treatment Devices, and Special Services (77300-77370) Decision-making services of physiciansDecision-making services of physicians –Treatment types –Dose calculation and placement (dosimetry) –Development of treatment device Stereotactic Radiation Treatment Delivery (77371-77373)Stereotactic Radiation Treatment Delivery (77371-77373) –Pay close attention to notes Delivers large dose to specific tumor siteDelivers large dose to specific tumor site

56. 56 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Radiation Treatment Delivery (77401-77423, 77520-77525) Technical component of actual delivery of radiationTechnical component of actual delivery of radiation –MeV (electrons) –Neutrons –Protons

57. 57 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Information Needed to Code Radiation Treatment Delivery Amount of radiation deliveredAmount of radiation delivered Type of radiation—electron (most common), neutron, or protonType of radiation—electron (most common), neutron, or proton(Cont’d…)

58. 58 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Information Needed to Code Radiation Treatment Delivery (…Cont’d) Number ofNumber of –Areas treated (single, two, three or more) –Ports involved (single, three or more, tangential) –Blocks used (none, multiple, custom)

59. 59 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Reporting Radiation Treatment Management (77427-77499) Professional (physician) portion of services, including:Professional (physician) portion of services, including: –Review port films –Review dosimetry, dose delivery, treatment parameters –Treatment set-up –Patient examination for medical E/M –Report in units of five fraction Unless last 3-4 fractions are at the end of the treatmentUnless last 3-4 fractions are at the end of the treatment –Count the last 3-4 as an additional fraction

60. 60 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Clinical Brachytherapy Placement of radioactive material into or around site of tumor:Placement of radioactive material into or around site of tumor: –Intracavitary (within body cavity) –Interstitial (within tissues) (Cont’d…) From Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKenna WG: Clinical Oncology, ed 3, Philadelphia, 2004, Churchill Livingstone.

61. 61 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Source (…Cont’d) Radioactive element delivers radiation dose over timeRadioactive element delivers radiation dose over time –Examples: Seeds, ribbons, or capsules –Ribbons: Seeds embedded on tape Tape cut to desired length controls amount of radiation and inserted into tissueTape cut to desired length controls amount of radiation and inserted into tissue(Cont’d…)

62. 62 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Clinical Brachytherapy Codes Divided Based On (…Cont’d) Number of sources applied:Number of sources applied: –Simple: 1-4 –Intermediate: 5-10 –Complex: 11+

63. 63 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Nuclear Medicine Placement of radioactive material into body and measurement of emissionsPlacement of radioactive material into body and measurement of emissions Used both for diagnosis and treatmentUsed both for diagnosis and treatment –Example: Stress test –Example: Stress test (Cont’d…)

64. 64 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Nuclear Medicine (…Cont’d) Codes divided primarily on organ systemCodes divided primarily on organ system –Exception: “Therapeutic,” for radiopharmaceutical therapies

65. 65 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Positron Emission Tomography (PET) 78811-7881678811-78816 Based on location (such as, skull base or chest)Based on location (such as, skull base or chest) Non-invasive imaging procedure that assesses perfusion and level of metabolic activity in various organ systemsNon-invasive imaging procedure that assesses perfusion and level of metabolic activity in various organ systems PET lesions in the liver From Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKenna WG: Clinical Oncology, ed 3, Philadelphia, 2004, Churchill Livingstone.

66. 66 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Conclusion CHAPTER 11 RADIOLOGY SECTION