Certification Review. Module 28. Medical Coding. Radiology

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Baldwin Norman
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Module 28 is the study of x-rays, using radiant energy and other imaging techniques, such as resonance imaging or ultrasound, to diagnose illnesses and diseases.

1 Module 28 is the study of x-rays, using radiant energy and other imaging techniques, such as resonance imaging or ultrasound, to diagnose illnesses and diseases. Vocabulary Barium enema (BE): lower gastrointestinal tract series using barium sulfate enema Barium sulfate: a radiopaque medium mixed with water that the patient is supposed to drink; used for gastrointestinal tract studies Computed tomography (CT): a form of x-ray that uses a CT scanner to look at multiple angles (views) of images of the body; especially helpful in diagnosing conditions of the bones, head, chest, and abdomen Contrast studies: use of a contrast medium by injection or orally Fluoroscopy: x-ray procedure that captures real-time video images of internal organs through the use of an image intensifier Interventional radiology: invasive radiology procedures, such as biopsies Iodine compounds: a radiopaque medium that consists of half fluid and iodine used in angiography, hysterosalpingography, myelography, and pyelography Magnetic resonance imaging (MRI): a diagnostic study that uses electromagnetic energy to diagnose conditions and diseases; MRI is not indicated for patients with pacemakers or implantable defibrillators, which could cause these devices to malfunction; may be performed with or without contrast medium Nuclear medicine physician: specialist trained in diagnostic nuclear medicine procedures, such as a thallium stress test Positron emission tomography (PET): a PET scan is used to observe the function of body organs; positron-emitting substances are administered by IV to create a cross-sectional image Radiologist: a physician who specializes in diagnostic radiology technician: a technician who specializes in taking x-rays Sonographer: a technician who specializes in ultrasound procedures Ultrasonography (U/S): uses high frequency sound waves to capture images of internal organs; techniques involve Doppler and color flow imaging 1

2 Planes and Positioning Abduction: away from Adduction: towards Anterior: front of the body Distal (distance): far from the trunk or point of attachment Eversion: turned outward Extension: extending outward; straightening a limb (ex/o means out) Flexion: bending; flexing a limb or muscle Frontal (coronal): vertical plane that divides the body into front & back (anterior & posterior) Inferior: below Inversion: turned inward Lateral: pertaining to the side; side of the body Posterior: behind Prone: lying on the belly (stomach); used to examine the back Recumbent: lying down Sagittal: lateral; a vertical plane that divides the body into right and left Superior: above; pertaining to the head Supine: lying on the back with the palms facing upward Transverse: across; a cross section dividing the body into upper and lower ( ) Codes from this section are divided into the following subsections. Diagnostic (Diagnostic Imaging) Diagnostic Ultrasound Radiologic Guidance Diagnostic ( ) 2 Breast, Mammography Bone/Joint Studies Radiation Oncology Nuclear Medicine A majority of common (standard) radiology procedures are found in this section. The codes are divided by anatomical site and by the views taken or approach Code Alert! Code has been revised. Code has been deleted.

3 The following subheadings may be found under the Diagnostic subsection of the CPT manual. Diagnostic (Diagnostic Imaging) Section SUBHEADING CODE RANGE SUBHEADING CODE RANGE Head and Neck Gastrointestinal Tract Chest Urinary Tract Spine and Pelvis Gynecological and Obstetrical Upper Extremities Heart Lower Extremities Vascular Procedures Abdomen Other Procedures Diagnostic Ultrasound ( ) Ultrasound uses high frequency sound waves that bounce off organs to produce an image. Ultrasound codes may also be located in the Medicine section of the CPT manual in addition to the section. The table below shows the subheadings and code ranges to assist you in coding radiology services. The type of scan is important and can be classified by the following terms. A mode: one dimensional B scan: two dimensional M mode: one dimensional with movement (M = movement) Real time scan: two dimensional with structure and movement Three locations for ultrasounds in the CPT manual Diagnostic Ultrasound Section SUBHEADING CODE RANGE SUBHEADING CODE RANGE Head and Neck Pelvis Nonobstetrical Chest 76604, Genitalia Abdomen and Retroperitoneum Extremities Spinal Canal Ultrasonic Guidance Procedures Pelvis Obstetrical Other Procedures

4 Noninvasive Vascular Diagnostic Studies Medicine Section SUBHEADING CODE RANGE Cerebrovascular Arterial Studies Extremity Arterial Studies (Including Digits) Extremity Venous Studies (Including Digits) Visceral and Penile Vascular Studies Extremity Arterial Venous Studies Other Noninvasive Vascular Diagnostic Studies Echocardiography Medicine Section Radiologic Guidance ( ) Fluoroscopic Guidance Computed Tomography Guidance Magnetic Resonance Guidance 2014 Code Alert! Codes and have been deleted. Breast, Mammography ( ) Computer aided detection: add-on code Unilateral or bilateral Medicare has special rules regarding frequency and coding of mammograms Bone / Joint Studies ( ) Bone density scans Radiation Oncology ( ) Clinical Treatment Planning (External and Internal Sources) ( ) Extensive notes Three levels of planning: 1. Simple: single treatment area, one port or one set of partial ports 2. Intermediate: three or more ports, multiple blocks, special time/dose restraints 3. Complex: complex blocking, custom ports, more than three treatment areas 4

5 2014 Code Alert! The guidelines in this subheading contain new or revised text. Code has been added. Three definitions of simulation 1. Simple: 1 treatment area 2. Intermediate: 2 separate treatment areas 3. Complex: 3 or more treatment areas, complex blocking Medical Radiation Physics, Dosimetry, Treatment Devices, and Special Services ( ) Dose calculations 2014 Code Alert! Code has been revised and resequenced. Stereotactic Radiation Treatment Delivery ( ) Other Procedures (77399) Radiation Treatment Delivery ( ) Port: areas that the radiation beam focuses on MeV: megaelectron volts; units to deliver radiation Neutron Beam Treatment Delivery ( ) Radiation Treatment Management ( ) Proton Beam Treatment Delivery ( ) Hyperthermia ( ) Hyperthermia: increased body temperature; may be used as a treatment for cancer Clinical Intracavitary Hyperthermia (77620) Insertion of a heat-producing probe into a cavity, such as the vagina Clinical Brachytherapy ( ) Placement of radioactive material directly into or surrounding a tumor 1. Intracavitary: within a body cavity 2. Interstitial: within the tissues Source: seeds, ribbons, or capsules; radioactive material delivered over time Ribbons: seeds that are embedded on tape; inserted into the tissue (interstitial); dose is regulated by cutting the tape to a desired length 5

6 Nuclear Medicine ( ) There are two subsections in this section: Diagnostic and Therapeutic. subsections are broken down by body system. Permanent placement of radionuclides within the body Stress tests: Cardiolite, thallium; bill for stress test and nuclear medicine portion Reversible ischemia: decreased blood flow to the heart muscle; no muscle death Irreversible ischemia: heart muscle death Code (oral), (IV), (intra-articular)b or (intraarterial) or the specific HCPCS Level II code for the radiopharmaceuticals in addition to the test The 6

Radiology CPT. CPT copyright 2011 American Medical Association. All rights reserved.

Radiology CPT. CPT copyright 2011 American Medical Association. All rights reserved. Radiology CPT CPT copyright 2011 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not