© 2010 Delmar, Cengage Learning Chapter 16 CPT Radiology.

© 2010 Delmar, Cengage Learning

Chapter 16

CPT Radiology

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Radiology Subsections

• The following subsections are further divided into anatomic categories:– Diagnostic radiology imaging– Diagnostic ultrasound– Radiation oncology– Nuclear medicine

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Diagnostic Imaging Subsection

• Includes:– Noninvasive diagnostic and therapeutic procedures

– Invasive diagnostic and therapeutic procedures

– Computerized tomography (CT)– Magnetic resonance imaging (MRI)

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Planes of View

• Coronal (frontal)• Midsagittal• Sagittal• Transverse (horizontal, axial)

(continued)

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Planes of ViewPlanes that separate body structures (midsagittal, sagittal, coronal, and transverse)

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Radiographic Projections

• Anteroposterior projection• Lateral projection (side view)

• Oblique projection• Posteroanterior (PA)

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Radiographic Projections

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Radiology Procedures

• Angiography• Aortography• Arthrography• Computed axial tomography (CT, CAT)

• Computed tomography angiography (CTA)

(continued)

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Radiology Procedures

• Nuclear imaging• Positron emission tomography (PET)

• Single photon emission computerized tomography (SPECT)

• Ultrasound (ultrasonography)• Venography• X-ray

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Radiology Procedures

• Cystography• Fluoroscopy• MRI

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Contrast Medium Injection Device

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Lateral Chest X-RayBones of the spine are white; soft tissues are shades of gray

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Abdominal CT ScanLiver is predominant in upper-left; stomach is visible in upper-right

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Fluoroscopy UnitDynamic radiographic examination that allows for visualization of flow of barium through gastrointestinal tract, injection of a contrast agent into the heart, etc.

Courtesy of GE Healthcare.

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Computed Tomography Sections

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3D Computed Tomography Angiography Reconstructions

(continued)

Carotid arteries

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3D Computed Tomography Angiography Reconstructions

Coronary arteries

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MRIIncludes stationary magnet, radio frequency coil, and gradient coils

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MRI of the BrainCourtesy of GE Healthcare

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Key Terms

• Roentgen (R, r)• Radiation absorbed dose (rad)• Gray (gy)• Roentgen-equivalent-man (rem)

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Radiology Procedures

• Three components:– Technical component– Professional component– Global service

• Modifiers:– -26 (professional component)– -TC (technical component)

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Coding Tips

• Modifier -50 (bilateral procedure) is not added to radiology procedures that are performed bilaterally because code descriptions often specify “bilateral.”

• Modifier -51 (multiple procedures) is not usually added to radiology codes.

• HCPCS level II anatomical modifiers -Lt and -Rt are added when appropriate.

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“Complete”

• Number of views required for study of a designated body part

• Do not confuse use in the code description with use in a parenthetical note below a code

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E/M Services Provided by Radiologist

• No code reported when radiologist provides E/M services as part of radiographic procedure

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Radiology Section Guidelines

• Provide instruction about:– Subject listings– Separate procedures– Subsection information– Unlisted service or procedure– Special report– Supervision and interpretation– Administration of contrast material(s)

– Written report(s)

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Radiology Subsections

• The following Radiology subsections contain notes unique to the subsection:– Diagnostic ultrasound– Radiation oncology– Nuclear medicine

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Separate Procedures

• Some procedures are considered an integral component of a total service or procedure and are identified by the descriptor “separate procedure.”

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Special Report

• When a service is new, unusual, or rarely provided, it requires a special report to validate the medical necessity and appropriateness of the service (e.g., complexity of symptoms).

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Component Coding

• Allows for reporting a radiology procedure code and a surgical procedure code to completely describe the service provided

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Radiology Coding

• To accurately code diagnostic radiology procedures, identify:– Anatomic site– Type of procedure– Number of views– Laterality of procedure – Use of contrast media

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Vascular Procedures

• Selective vascular catheterization

• Nonselective vascular catheterization

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Coding Tip

• Report a separate code when a diagnostic angiography or venography is performed during a separate session (from the interventional procedure).

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Ultrasound Display Modes

• A-mode (amplitude modulation)• B-scan (brightness mode, gray-scale ultrasound)

• M-mode (motion mode)• Real-time scan

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Ultrasound Guidance Procedures

• Report either a diagnostic ultrasound or guidance ultrasound code, but not both for the same patient during the same encounter.

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Radiation Oncology

• Radiation oncology codes include professional services and technical procedures that are organized according to types of treatment provided:– Consultation– Clinical treatment planning– Radiation treatment delivery– Neutron beam treatment delivery

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Clinical Treatment Planning

• External sources• Internal sources• Systemic radiation therapy• Stereotactic radiosurgery (SRS)

• Stereotactic body radiation therapy (SBRT)

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Coding Tip

• Clinical treatment planning is reimbursed:– Once per course of radiation therapy– Only when performed directly by radiation oncologist

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Therapeutic Radiology Treatment

• Types of planning:– Simple– Intermediate– Complex

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Radiation Treatment Delivery

• Includes ongoing patient evaluation (codes not reported separately)

• Codes are reported for administration of radiation therapy per treatment

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Nuclear Medicine

• Subsection contains two headings:– Therapeutic– Diagnostic