April 1, 2009 RADIOLOGY GENERAL RADIOLOGY G-1

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1 GENERAL Head and Neck Skull - routine (includes Towne s views) Sella turcica Facial bones Nose Mandible Temperomandibular joints Sinuses Mastoids - acute chronic Teeth - up to ¼ set up to ½ set full set bitewing Eye, for foreign body for localization (stereo-optics), additional Optic foramina Salivary gland region Neck for soft tissues Internal auditory canal Special additional view of any head and neck item Spine and Pelvis Cervical spine Thoracic spine Lumbar or lumbosacral spine Sacrum and/or coccyx Pelvis - single view Pelvis and hips Sacroiliac joints Spine - scoliosis series Ribs - unilateral for bilateral, extra Sternum Special additional view of any spine and pelvis item Extremities Clavicle Sternoclavicular joint Acromioclavicular joints - bilateral (with or without weighted distraction) Shoulder Scapula Humerus Elbow Ulna and radius Wrist Wrist and Hand Hand Finger Thumb, including metacarpals Scaphoid Hip Hip pinning, interpretation only G-1

2 GENERAL (Cont d) Extremities (Cont d) Femur Orthoroentgenogram Knee (including patella) Tibia and fibula Ankle Calcaneous Foot Toe Special additional view of any item in the section headed extremities Post reduction check Skeletal Surveys Skeletal survey for bone age single film or more films or views Other Surveys basic for rheumatoid survey basic for metabolic survey basic for metastatic survey plus per film or view for either of the above Chest Single film views or more views Mammography - unilateral bilateral Screening mammography program NOTE: Fee code should be claimed for screening mammograms performed at either the Health Care Corporation in St. John s or at the James Paton Memorial Hospital as part of the screening program established by the Department of Health and Community Services. All other mammograms performed and reported at these and other sites should continue to be billed as either fee code or Abdomen Survey film (not to be billed in addition to 70601) Additional film studies (acute abdomen) Oesophagus Stomach and duodenum Stomach and duodenum with small intestinal series Small bowel only Upper GI - double contrast Colon - barium enema with air study Defecography Cholecystogram T-Tube cholangiogram Operative cholangiogram, interpretation only Intravenous cholangio - tomography Intravenous cholangiogram G-2

3 GENERAL (Cont d) GU Tract Survey film Retrograde pyelogram Intravenous pyelogram with nephrotomogram Diuretic washout or infusion IVP with nephrotomogram Urethrocystogram Stress urethrocystogram Voiding urethrocystogram Vasography Nephrostogram Obstetrics and Gynaecology Survey film Pelviometry Placentogram Hysterosalpingogram Intra-uterine foetal transfusion - radiological control G-3

4 SPECIAL PROCEDURES Arteriography - General Flush aortograph - includes aortic root, thoracic, lumbar and retrograde femoral procedure interpretation Translumbar aortography procedure interpretation Single selective arteriogram (renal, celiac, mesenteric, carotid, vertebral, splenic, subclavian, femoral and hepatic, etc) procedure interpretation Bilateral and multiple selective arteriograms procedure interpretation Percutaneous femoral procedure interpretation Percutaneous brachial procedure interpretation Percutaneous angioplasty procedure interpretation Embolization, e.g., for treatment of haemangioma or renal carcinoma (add to angiographic procedural fees) Percutaneous removal of intravascular foreign bodies Intra-arterial infusion of drugs, e.g., for control of gastrointestinal haemorrhage, charge appropriate angiographic procedural and radiological fees plus a per diem supervision fee of Percutaneous transhepatic catheter portal venography Venous Studies Vena cavagram procedure interpretation Percutaneous insertion of vena cava filter Selective venography (spinal, hepatic, axillary, lumbar, renal and thymic, etc.) procedure interpretation Selective bilateral and multiple (e.g., renal vein studies) procedure interpretation Single peripheral venogram (lower limb, orbital, etc.) procedure interpretation Bilateral peripheral and pelvic procedure interpretation Splenoportogram procedure interpretation Lympangiogram - single procedure interpretation G-4

5 SPECIAL PROCEDURES (Cont d) Venous Studies (Cont d) Lymphangiogram - bilateral procedure interpretation Cardiac Angiography All cardiac angiography except bilateral coronary studies interpretation Bilateral coronary angiography interpretation Neuro Angiogrphy Percutaneous embolization of spinal or cerebral AV malformations Carotid or vertebral artery occlusion by detachable balloon - percutaneous Percutaneous carotid angiogram - single (brachial) procedure interpretation Percutaneous carotid angiogram - bilateral procedure interpretation For repeat angiograms (oblique vies, stereo magnification, basil, etc.) procedure - single interpretation - single procedure - bilateral interpretation - bilateral Myelogram (complete) prone procedure interpretation Myelogram - supine (second puncture) procedure... add Posterior fossa myelogram procedure... add Discography procedure interpretation Discography (each additional level) procedure... add Risagram interpretation Gastro-Intestinal Sialogram procedure interpretation Insertion of nasogastric tube procedure Ba. swallow H-type fistula procedure interpretation... IC Percutaneous gastrostomy G-5

6 SPECIAL PROCEDURES (Cont d) Gastro-Intestinal (Cont d) Hypotonic duodenography procedure interpretation... IC Biliary duct calculus removal via T-Tube tract Percutaneous transhepatic biliary drainage including biliary stenting Transhepatic cholangiogram procedure interpretation Change of biliary drainage tube Injection of biliary drainage tube for reassessment ERCP - total procedure performed by a Radiologist interpretation Small bowel enema procedure interpretation Reduction of intussusception procedure interpretation... IC Oral or percutaneous placement of jejunostomy tube Gastrografin enema procedure interpretation... IC Pneumoperitoneal and retroperitoneal air insufflation procedure interpretation Sinogram procedure interpretation Dacrocystogram procedure interpretation Abscess management (intra-abdominal or deep organ) i.e. localization, placement of tube, drainage under fluoroscopy, ultrasound and/or CT Respiratory System Laryngogram procedure interpretation Single bronchogram procedure interpretation Bilateral bronchogram procedure interpretation Percutaneous lung biopsy procedure interpretation... IC Injection of air into the anterior mediastinum procedure interpretation G-6

7 SPECIAL PROCEDURES (Cont d) Respiratory System (Cont d) Injection of contrast into pleural cavity procedure interpretation Genito-Urinary Hysterosalpingogram procedure (fluoroscopy) interpretation Kidney film procedure (fluoroscopy) interpretation Percutaneous antegrade insertion of ureteric stent Change of nephrostomy tube Cyst puncture (renal) procedure interpretation... IC Injection of dye into cystic cavity procedure interpretation Loopogram procedure interpretation Catheterization procedure interpretation... IC Percutaneous nephrostomy performed by a Radiologist Orthopaedic procedure interpretation G-7

8 OTHER ITEMS Other Mammary ductography Intra-mammary needling for localization under mammographic control (procedure and interpretation - unilateral Special Visit Premiums Daytime special visit (Monday to Saturday) Evening (6:00 p.m. to midnight) and Sunday and Statutory Holidays Night (midnight to 8:00 a.m.) NOTE: The above special visit premiums are payable in addition to the x-ray examination fees; however, only one premium per trip is payable regardless of the number of x-rays examined. IV Injections Adult Cut-down Paediatric IV injection Scalp vein or cut-down Catheterization Injection - bursae, joints or tendon sheath Tomography plane planes Fluoroscopy Fluoroscopy alone, of any part Fluoroscopy control of a procedure done by another physician, per ¼ hour or part thereof (IC required indicating the name of the procedure, the physician who did the procedure and the amount of time involved.) G-8

9 DIAGNOSTIC ULTRASOUND Procedure codes indicated as IC must be billed IC indicating why the procedure had to be done by the Radiologist. See item 11.4 of the Preamble. General Ultrasound control of a procedure, done by another physician, per ¼ hour or part thereof (IC required indicating the name of the procedure, the physician who did the procedure and the amount of time involved) Head and Neck Echoencephalography - midline, A-mode interpretation procedure (IC) Complete (midline and ventricular size) interpretation procedure (IC) Echography - ophthalmic Quantitative, A-mode interpretation procedure (IC) B-scan immersion interpretation procedure (IC) B-scan contact interpretation procedure (IC) Biometry (axial length - A-mode) interpretation procedure (IC) Foreign body localization interpretation... IC procedure (IC) Echography - neck (e.g., thyroid, neck mass or other pathology including A and/or B scans) interpretation procedure (IC) Neonatal/paediatric cranial scan - complete interpretation procedure (IC) Neonatal/paediatric spinal scan - complete interpretation procedure (IC) Heart/Major Blood Vessel Echography, pericardial effusion, M-mode interpretation procedure (IC) Ultrasound pericardiocentesis procedure and interpretation Echocardiography Complete study - 1 dimension interpretation procedure (IC) Complete study - 2 dimensions interpretation procedure (IC) and 2 dimension study on same patient visit interpretation procedure (IC) G-9

10 DIAGNOSTIC ULTRASOUND (Cont d) Heart/Major Blood Vessel (Cont d) Limited study 1 or 2 dimensions for follow-up studies interpretation procedure (IC) Doppler echocardiography interpretation procedure (IC) Aorta only interpretation procedure (IC) Vena cava only interpretation procedure (IC) Peripheral Vascular System Extra-cranial vessel assessment (bilateral, carotid and/or subclavian and/or vertebral arteries) Doppler scan or B scan frequency analysis frequency analysis with Doppler scan duplex scan, i.e. simultaneous real time, B-mode imaging and spectral analysis Duplex Doppler assessment of hepatic and portal venous systems interpretation procedure Post-operative organ transplant arterial and/or venous Doppler assessment (assessment of the vascularity to the organ transplant rather than the ultrasound examination of the organ itself) interpretation procedure Transcranial Doppler assessment interpretation procedure Peripheral artery evaluation (not to be billed routinely with 72241, or 72243) Doppler scan or B-scan frequency analysis frequency analysis with Doppler scan duplex scan, i.e. simultaneous real time, B-mode imaging and spectral analysis Venous evaluation - duplex scan i.e. simultaneous real time, B-mode imaging interpretation procedure Duplex Doppler assessment of post-operative shunts interpretation procedure Doppler assessment of intra-abdominal vessels interpretation procedure Thorax Chest masses, pleural effusion - A and B-mode interpretation procedure (IC) Ultrasonic thoracentesis procedure and interpretation Breast masses - scan B-mode (per breast) interpretation procedure (IC) G-10

11 DIAGNOSTIC ULTRASOUND (Cont d) Abdomen and Retroperitoneum Abdominal scan, major (includes multiple organs and/or spaces) interpretation procedure (IC) Abdominal scan, limited (e.g. single organ or follow-up study) interpretation procedure (IC) Scrotum Testicular (1 or both) or scrotal scanning interpretation procedure (IC) Obstetrics, Gynaecology and Pelvis Echography - Scan B-mode Early pregnancy diagnosis interpretation procedure (IC) Foetal age determination interpretation procedure (IC) Placenta localization interpretation procedure (IC) IUCD localization interpretation procedure (IC) Pregnancy, complete interpretation procedure (IC) Foetal assessment in - utero for physical condition of the fetus (requested by the specialist) interpretation and procedure Pelvic mass interpretation procedure (IC) Endocavitary Scan interpretation procedure Transvaginal sonohysterography, includes procedure, interpretation and introduction of saline or other intracavitary contrast media Ultrasonic amniocentesis interpretation and procedure G-11

12 DIAGNOSTIC ULTRASOUND (Cont d) Extremities Extremities, per limb (excluding vascular study) interpretation procedure (IC) Scan of popliteal space interpretation procedure (IC) NOTES: 1. A-mode - implies a one-dimensional ultrasonic measurement procedure. 2. M-mode - implies a one-dimensional ultrasonic measurement procedure with movement of the trace to record amplitude and velocity of moving echo-producing structures. 3. Scan B-mode - implies a two-dimensional ultrasonic scanning procedure with a two-dimensional display. THERAPEUTIC ULTRASOUND Occlusion of femoral or brachial pseudo-aneurysm under colour Doppler ultrasound guidance G-12

13 COMPUTED TOMOGRAPHY Head without IV contrast with IV contrast with and without IV contrast Complex head without IV contrast with IV contrast with and without IV contrast Neck without IV contrast with IV contrast with and without IV contrast Thorax without IV contrast with IV contrast with and without IV contrast Abdomen without IV contrast with IV contrast with and without IV contrast Extremities (1 or more) without IV contrast with IV contrast with and without IV contrast Spine(s) without IV contrast with IV contrast with and without IV contrast Pelvis without IV contrast with IV contrast with and without IV contrast G-13

14 MAGNETIC RESONANCE IMAGING Head multislice SE (1 or 2 echos) multislice IR repeat (another plane, different pulse sequence - max. 2) when gating is performed, (fee = 30% of applicable imaging fee)... IC Neck multislice SE (1 or 2 echos) multislice IR repeat (another plane, different pulse sequence - max. 2) Thorax multislice SE (1 or 2 echos) multislice IR repeat (another plane, different pulse sequence - max. 2) when gating is performed, (fee = 30% of applicable imaging fee)... IC Abdomen multislice SE (1 or 2 echos) multislice IR repeat (another plane, different pulse sequence - max. 2) when gating is performed, (fee = 30% of applicable imaging fee)... IC Pelvis multislice SE (1 or 2 echos) multislice IR repeat (another plane, different pulse sequence - max. 2) Extremity multislice SE (1 or 2 echos) multislice IR repeat (another plane, different pulse sequence - max. 2) Spine Spinal segments recognized are cervical, thoracic, and lumbo-sacral Limited spine -1 segment multislice SE (1 or 2 echoes) multislice IR repeat (another plane, different pulse sequence - max 2) Intermediate spine - 2 adjoining segments multislice SE multislice IR repeat (another plane, different pulse sequence - max. 2) Complex spine - 2 or more non-adjoining or complete segments multislice SE multislice IR repeat (another plane, different pulse sequence - max. 2) When gating of spine is performed, (fee = 30% of applicable imaging fee)... IC DIAGNOSTIC BIOPSY Image-guided biopsy, any organ, by any radiographic technique G-14