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CHAPTER 24

CHAPTER 24. RADIOLOGY. Radiology. Radiology: Branch of medicine that uses radiant energy to diagnose and treat patients Specialist in radiology: Radiologist (doctor of medicine). Radiology Subsections. Diagnostic Radiology Aorta and arteries Diagnostic Ultrasound Radiologic Guidance

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CHAPTER 24

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  1. CHAPTER 24 RADIOLOGY

  2. Radiology Radiology: Branch of medicine that uses radiant energy to diagnose and treat patients Specialist in radiology: Radiologist (doctor of medicine)

  3. Radiology Subsections Diagnostic Radiology Aorta and arteries Diagnostic Ultrasound Radiologic Guidance Breast, Mammography Bone/Joint Studies Radiation Oncology Clinical Brachytherapy Nuclear Medicine

  4. Terms Fluoroscopy views inside of body, projects onto television screen Live images by which physician can view function and structure of organ Example: 71047, 76000, Chest x-ray with fluoroscopy

  5. Magnetic Resonance Imaging (MRI) (1 of 2) MRI uses magnetic energy to view soft tissue structures Example: 72148, MRI of lumbar spine canal

  6. MRA—Magnetic Resonance Angiography—is application of MRI that provides visualization of blood flow, as well as images of normal and diseased blood vessels Magnetic Resonance Imaging (MRI) (2 of 2) Figure 24.12 Modified from Bradley WG, Daroff RB, Fenichel GM, Jankovic J: Neurology in Clinical Practice, ed 5, Philadelphia, 2008, Butterworth-Heinemann.

  7. Tomography or CT Tomography used to view single plane of body Example: 70450, Tomographic scan of head or brain

  8. CT Scan of Lung Carcinoma A, A patient with right hilar lung carcinoma and mediastinal adenopathy showing the margins of the bones. B, The scan can be set to show the soft tissue. C, The lung organs can be shown by using additional scan settings. There is greater detail than would be obtained with conventional radiographs. (Courtesy of Bruce Porter, MD.)

  9. Biometry Biometry: Application of statistical methods to biological facts Example: 76516, Use of ultrasound echography in biometry of eye Ultrasound diagnostic noninvasive procedures are performed to determine composition and contours of ocular and orbital structures

  10. Planes of Body • Imaginary lines used as points of reference Figure 24.1

  11. Position and Projection Position: Way in which patient placed Projection: Path x-ray beam travels

  12. Terminology Radiology uses a wide variety of terms and abbreviations specific to planes, positions, and projections

  13. Component Coding Three component terms Professional Technical Global

  14. Professional Component (-26) Physician 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. Technical Component (-TC) Technologist’s services Equipment, film, and supplies From Long BW, Frank ED, Ehrlich RA: Radiography Essentials for Limited Practice, ed 4, St. Louis, 2013, Saunders.

  16. Global Procedure Both 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 service No modifier -TC No modifier -26

  17. Component Modifiers (1 of 2) If only professional component of radiology service provided append modifier -26 to code

  18. Component Modifiers (2 of 2) If only technical component was provided append modifier -TC to code Modifier -TC: HCPCS modifier used with CPT and HCPCS codes

  19. Global Procedure If both professional and technical components of radiology service provided, use no modifier

  20. For Example: Chest X-Ray Professional component: 71048-26 (Supervision and final report) Technical component: 71048-TC (Technician, supplies, equipment) Global procedure: 71048 (both professional and technical)

  21. Global Procedure: reimbursement Third-party payers usually reimburse 40% professional component 60% technical component 100% global procedure

  22. Contrast Material (1 of 2) Statement “with contrast” implies injection built into code

  23. Contrast Material (2 of 2) Notes indicate codes for components Example: 75893, venous sampling indicates “(For procedure, use 36500)” Oral or rectal contrast does not qualify for “with contrast”

  24. Overview of Radiology Subsections Diagnostic Radiology Diagnostic Ultrasound Radiologic Guidance Breast, Mammography Bone/Joint Studies Radiation Oncology Nuclear Medicine

  25. Diagnostic Radiology (1 of 2) “Complete” in a code description in radiology section, means all views taken of specified body site Most standard radiographic procedures Codes often divided on whether contrast material used Codes further divided on number views

  26. Diagnostic Radiology (2 of 2) Used to: Diagnose disease Monitor disease process—progression or remission

  27. Diagnostic Procedures Include X-ray Computerized axial tomography (CAT or CT scan) Magnetic resonance imaging (MRI) Angiography Subdural hematoma From Mettler FA: Essentials of Radiology, ed 3, Philadelphia, 2014, Saunders. CT of renal artery From Mettler FA: Essentials of Radiology, ed 3, Philadelphia, 2014, Saunders. From Walsh PC, editor: Campbell's Urology, ed 8, Philadelphia, 2002, Saunders.

  28. Computerized Axial Tomography X-ray image taken in sections Computer reconstructs and enhances image

  29. Magnetic Resonance Imaging Uses magnetic fields to produce an image displayed on computer screen Codes of same area (e.g., spine) divided on whether or not contrast material used

  30. Angiography (1 of 3) Used to view vessel obstructions Dye injected into vessel

  31. Angiography (2 of 3) Angiography of aortic arch and brachiocephalic vessels Figure 24.13 From Stimac GK: Introduction to Diagnostic Imaging, Philadelphia, WB Saunders, 1992, p 447.

  32. Angiography (3 of 3) Radiologist uses angiography to diagnose vascular conditions Examples: Malformations Strokes Myocardial infarctions

  33. Remember If fewer than total number of views specified in code provided: Use modifier -52, Reduced Service

  34. Diagnostic Ultrasound (1 of 2) Uses 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 organ

  35. Diagnostic Ultrasound (2 of 2) Ultrasound showing a gallstone Figure 24.14 From Goldman L, Schafer AI, editors: Goldman’s Cecil Medicine, ed 24, Philadelphia, 2012, Saunders.

  36. Subheadings Subheadings of Diagnostic Ultrasound primarily based on anatomy Example: Head and Neck Chest Pelvis Many notes in subsection directing correct assignment

  37. Three Locations for Ultrasound Services 76506-76999: Radiology codes for diagnostic ultrasound services 93880-93998: Medicine codes for vascular studies 93303-93355: Medicine codes for echocardiography

  38. Interventional Radiologist Combination radiologist and surgeon Provides 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 or HCPCS code)

  39. Ultrasound Modes and Scans A-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 structures B-scan technology—two-dimensional Real-time scan A & B scan may be performed together (medical necessity documented)

  40. A-Mode A = Amplitude Technique used to map structure outline Displays one-dimensional image

  41. M-Mode M = Motion Technique used to display movement of structure Displays one-dimensional image

  42. B-Scan B = Brightness Technique used to display movement of tissues and organs Known as gray scale ultrasound Displays two-dimensional image

  43. Real-Time Scan Technique used to display both structure and motion with time of organ and tissues Displays two-dimensional image

  44. Extent of Study (1 of 2) Codes often divided on extent of study Example: Extent of scan as follows

  45. Extent of Study (2 of 2) Complete: Scans entire body Limited: Scans part of body, i.e., one organ Follow-up/repeat: Limited study of part of body that was scanned previously

  46. Radiologic Guidance, Breast, Mammography, Bone/Joint Studies, and Radiation Oncology Radiologic Guidance (77001-77022) Fluoroscopic, computed tomography, magnetic resonance imaging guidance, and other Breast, Mammography (77046-77063) Such as screening, and computer-aided detection Bone/Joint Studies (77071-77086) Such as bone density and joint survey Radiation Oncology (77261-77799) Therapeutic use of radiation Codes for both professional and technical services Subheading divided based on treatment

  47. Radiation Oncology Initial consultation, prior to decision to treat, reported with E/M Consultation code Outpatient: 99241-99245 Inpatient: 99251-99255 Follow consultation criteria: Document who and why

  48. Clinical Treatment Planning—Professional Component Includes: Interpretation of special testing Tumor localization Determination of treatment volume

  49. Clinical Treatment Planning (1 of 2) Choice of treatment method Determination of number of treatment ports Selection of treatment devices Other necessary procedures

  50. Clinical Treatment Planning (2 of 2) Clinical Treatment Planning consists of Three types of treatment plans For all patients requiring radiation therapy

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