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
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 (70010 79999) Codes from this section are divided into the following subsections. Diagnostic (Diagnostic Imaging) Diagnostic Ultrasound Radiologic Guidance Diagnostic (70010 76499) 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. 2014 Code Alert! Code 72040 has been revised. Code 75960 has been deleted.
The following subheadings may be found under the Diagnostic subsection of the CPT manual. Diagnostic (Diagnostic Imaging) Section 70010 76499 SUBHEADING CODE RANGE SUBHEADING CODE RANGE Head and Neck 70010 70559 Gastrointestinal Tract 74210 74363 Chest 71010 71555 Urinary Tract 74400 74485 Spine and Pelvis 72010 72295 Gynecological and Obstetrical 74710 74775 Upper Extremities 73000 73225 Heart 75557 75574 Lower Extremities 73500 73725 Vascular Procedures 75600 75989 Abdomen 74000 74190 Other Procedures 76000 76499 Diagnostic Ultrasound (76506 76999) 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 76506 76999 SUBHEADING CODE RANGE SUBHEADING CODE RANGE Head and Neck 76506 76536 Pelvis Nonobstetrical 76830 76857 Chest 76604, 76645 Genitalia 76870 76873 Abdomen and Retroperitoneum 76700 76776 Extremities 76881 76886 Spinal Canal 76800 Ultrasonic Guidance Procedures 76930 76965 Pelvis Obstetrical 76801 76828 Other Procedures 76970 76999 3
Noninvasive Vascular Diagnostic Studies Medicine Section 93880 93998 SUBHEADING CODE RANGE Cerebrovascular Arterial Studies 93880 93893 Extremity Arterial Studies (Including Digits) 93922 93931 Extremity Venous Studies (Including Digits) 93965 93971 Visceral and Penile Vascular Studies 93975 93982 Extremity Arterial Venous Studies 93990 Other Noninvasive Vascular Diagnostic Studies 93998 Echocardiography Medicine Section 93303 93352 Radiologic Guidance (77001 77022) Fluoroscopic Guidance Computed Tomography Guidance Magnetic Resonance Guidance 2014 Code Alert! Codes 77031 and 77032 have been deleted. Breast, Mammography (77051 77059) Computer aided detection: add-on code Unilateral or bilateral Medicare has special rules regarding frequency and coding of mammograms Bone / Joint Studies (77071 77084) Bone density scans Radiation Oncology (77261 77799) Clinical Treatment Planning (External and Internal Sources) (77261 77299) 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
2014 Code Alert! The guidelines in this subheading contain new or revised text. Code 77293 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 (77295 77370) Dose calculations 2014 Code Alert! Code 77295 has been revised and resequenced. Stereotactic Radiation Treatment Delivery (77371 77373) Other Procedures (77399) Radiation Treatment Delivery (77401 77425) Port: areas that the radiation beam focuses on MeV: megaelectron volts; units to deliver radiation Neutron Beam Treatment Delivery (77422 77423) Radiation Treatment Management (77427 77499) Proton Beam Treatment Delivery (77520 77525) Hyperthermia (77600 77615) 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 (77750 77799) 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
Nuclear Medicine (78012 79999) 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 79005 (oral), 79101 (IV), 79440 (intra-articular)b or 79445 (intraarterial) or the specific HCPCS Level II code for the radiopharmaceuticals in addition to the test The 6