1. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 9-1 Chapter 9 Radiology Coding

2. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Learning Objectives 9.1 Distinguish technical components from professional components. 9.2 Correctly apply guidelines regarding screening versus diagnostic services. 9.3 Apply the guidelines to determine how to code the administration of contrast materials. 9-2

3. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Learning Objectives (cont.) 9.4 Recognize diagnostic radiologic services. 9.5 Decide when to code radiation treatments. 9.6 Determine how to accurately report nuclear medicine services. 9-3

4. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Key Terms Angiography Arthrography Computed tomography (CT) Computed tomography angiography (CTA) Fluoroscope Magnetic resonance arthrography (MRA) 9-4

5. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Key Terms (cont.) Magnetic resonance arthrography (MRA) Magnetic resonance imaging (MRI) Nuclear medicine Radiation Sonogram Venography 9-5

6. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Technical vs. Professional Technical –Equipment –Technician –Maintenance and utilities (electricity, etc.) –Supplies Professional –Healthcare professional, radiologist, or physician, who supervises and interprets the images taken and writes a report 9-6

7. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Screening vs. Diagnostic Screening –Patient has no signs or symptoms –Part of a regular preventive checkup Diagnostic –Patient has signs or symptoms of disease –Taken to assist in the identification and/or confirmation of a suspected condition or diagnosis 9-7

8. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Imaging Views AP Anteroposterior: Front to back PA Posteroanterior: Back to front O Oblique: At an angle RAO Right anterior oblique: At an angle from the right front RPO Right posterior oblique: At an angle from the right back 9-8

9. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Imaging Views LAO Left anterior oblique: At an angle from the left front LPO Left posterior oblique: At an angle from the left back Lat Lateral (lat): From one side to the other side If fewer than the minimum number of views, use modifier 52 Reduced Services 9-9

10. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Procedures With or Without Contrast “With contrast” means that the technician or physician administered a substance to enhance the image If radiographic arthrography is performed, use an additional code for the supervision and interpretation of the appropriate joint 9-10

11. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Procedures With or Without Contrast (cont.) “With contrast” guidelines –Contrast administered intravenously is already included in the code and should not be reported separately –Contrast administered intra-articularly (into a joint) or intrathecally (into a tendon or sheath) needs additional code –Oral or rectal contrast is not considered “with contrast” 9-11

12. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Procedures With or Without Contrast (cont.) CT or MR arthrography performed without radiographic arthrography –Requires three different codes Code for the imaging guidance (fluoroscopy) Code for the injection of the contrast Code for the appropriate CT or MR 9-12

13. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Other types of radiologic procedures –Positron emission tomography (PET) Time exposure picture of cellular biologic activities –Bone density scan (DEXA) Osteoporosis screenings –Nuclear medicine scan Assesses organ system function 9-13

14. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Diagnostic Radiology Diagnostic Angiography –Some codes include a diagnostic angiography done at the same time as therapeutic procedure –Some procedures should be coded separately If a full diagnostic study is done If there is a change in patient’s condition If prior test does not show applicable anatomy 9-14

15. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Diagnostic Radiology (cont.) Diagnostic angiography for interventional procedures should not be coded separately –Vessel measurement –Postangioplasty or stent angiography –Contrast injections, angiography, road mapping, and/or fluoroscopic guidance for the interventional procedure 9-15

16. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Diagnostic Radiology (cont.) Diagnostic Venography –Some codes include diagnostic venography when performed at the same time –Some procedures should be coded separately If a full diagnostic study is done If there is a change in patient’s condition If prior test does not show applicable anatomy 9-16

17. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Diagnostic Radiology (cont.) Transcatheter Procedures –Therapeutic transcatheter radiologic codes include Vessel measurement Post-angioplasty or stent venography Contrast injections, angiography/venography, road mapping, and/or fluoroscopic guidance Coded separately from diagnostic angiography/venography unless specified 9-17

18. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Diagnostic Ultrasound –Identify complete or limited –Ultrasound performed without evaluation, recording, and final written reported cannot be coded separately 9-18

19. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Diagnostic Ultrasound (cont.) –Identify type of scan A mode (one-dimensional) M mode (one-dimensional with movement of trace) B scan (two-dimensional) Real-time scan (two-dimensional with motion with time) –If the report indicates that a Doppler evaluation of vascular structures was performed, code this separately 9-19

20. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Mammography May be Screening or Diagnostic –Code 77055 unilateral –Code 77056 bilateral –Code 77057 bilateral (2-view film study of each breast) –Code 77051 additional code for computer- aided detection (CAD) 9-20

21. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Diagnostic Radiology (cont.) Bone and Joint Studies –Bone studies help identify the degree of maturation of a child’s bones –CT scanography helps to determine leg length discrepancies –Osseous survey helps to identify fractures, tumors, degenerative conditions of the bone –Bone mineral density (BMD) used to measure bone loss 9-21

22. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Radiation Oncology Codes include –Initial consultation –Clinical treatment planning –Simulation –Medical radiation physics 9-22

23. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Radiation Oncology (cont.) Codes include (cont.) –Dosimetry –Treatment devices –Special services –Clinical treatment management procedures –Normal follow-up care during treatment and 3 months following completion of treatment 9-23

24. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Radiation Oncology (cont.) Services in varying degrees of intensity –Simple planning One treatment area –Intermediate planning Two separate treatment areas –Complex planning Three or more separate treatment areas 9-24

25. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Nuclear Medicine Several types of nuclear medicine services –Bone scans used to investigate injuries –Thyroid uptake scans used to assess thyroid function and record structure of the gland –Heart scans used to measure heart function, evaluate existence of heart muscle damage 9-25

26. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Nuclear Medicine (cont.) Several types of nuclear medicine services –Lung scans used to determine the presence of blood clots –Hepatobiliary scans used to evaluate the function of the liver and gallbladder –Gallium scans used to identify presence of infection and some types of tumors 9-26

27. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Nuclear Medicine (cont.) These codes do NOT include diagnostic or therapeutic radiopharmaceuticals (drugs) Code administration and the drug itself separately 9-27

28. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Chapter Summary Imaging methodology has advanced tremendously. Coders must be knowledgeable about these techniques to code properly. Procedures with contrast and without contrast, CT scans, MRIs, sonograms, and so many more enable professionals to look inside the patient in a noninvasive manner. 9-28