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RADIOLOGY CODING BASICS

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Title: RADIOLOGY CODING BASICS


1
RADIOLOGY CODING BASICS
  • Presented by
  • WENDIE POND, CPC (former RCC)
  • Healthcare Billing and Coding Consultant

2
What is an RCC?
3
What is an RCC?
REAL COOL CODER?
4
What is an RCC?
REAL COOL CODER?
REALLY CRAZY CHICK?
5
What is an RCC?
REAL COOL CODER?
REALLY CRAZY CHICK?
RADIOLOGY CERTIFIED CODER!!!!
6
RBMA
  • RBMA-Radiology Business Management Association
  • Founded in 1968, is the only radiology-specific
    business organization in existence today. Its
    purpose is to provide Radiology managers with
    information, resources, education and networking
    to run a successful radiology business.
  • The RBMA recognized the importance of radiology
    coding in the business of radiology and approved
    the development and funding of the first
    nationally recognized radiology specific coding
    exam.
  • In the spring of 2000 the Radiology Coding
    Certification Board (RCCB) was formalized.

7
RCCB
  • RCCB-Radiology Coding Certification Board
  • A non-profit organization established in May
    2000, committed to promoting the highest
    standards of radiology coding through the
    credentialing of radiology coders.
  • The RCCB has certified over 1682 coders to date.
    Currently there are only 35 RCCs in Washington
    State.

8
What Makes Radiology Coding so Different?
  • Its subjective
  • After all its a PHOTO
  • Photos are hard to diagnoseRight?

9
What Makes Radiology Coding so Different?
  • Its subjective

10
What Makes Radiology Coding so Different?
  • Its subjective

11
What Makes Radiology Coding so Different?
  • Its subjective

12
What Makes Radiology Coding so Different?
  • Its subjective

13
PHOTOS ARE SUBJECTIVE
  • Appears to be
  • Consistent with
  • Similar to
  • Suggestive of
  • NOT CODEABLE LANGUAGE

14
Some things are Obvious!
15
RULE OUTS
  • Images are often ordered to Rule Out a
    condition.
  • Patient complains of RUQ Abdominal pain.
    Rule out cholelithiasis
  • Shortness of Breath for 2 days, Rule out
    Pulmonary Embolism
  • Lower leg pain and swelling, Rule out DVT

16
WHATS CODEABLE??
  • ABDOMINAL ULTRASOUND IS ORDERED

17
WHATS CODEABLE??
  • ABDOMINAL ULTRASOUND IS ORDERED
  • Reason for Visit
  • Rule-out Hernia

18
WHATS CODEABLE??
  • ABDOMINAL ULTRASOUND IS ORDERED
  • Reason for Visit
  • Rule-out Hernia
  • Findings
  • No Hernia Found

19
WHATS CODEABLE??
  • ABDOMINAL ULTRASOUND IS ORDERED
  • Reason for Visit
  • Rule-out Hernia
  • Findings
  • No Hernia Found
  • NOTHINGTHE CODER NEEDS FINDINGS or
    SYMPTOMS. IN OTHER WORDSWHAT IS IT THAT MAKES
    THE REFERRING PHYSICIAN THINK THERE IS A
    HERNIA????

20
MAMMOGRAPHY REPORT
  • Patient presents with palpable lump found during
    routine breast exam.
  • Mammography findings state the following
  • 2cm mass seen at 2 oclock in the left breast
    is consistent with DCIS (ductal carcinoma
    in-situ). Ultrasound guided breast biopsy has
    been scheduled.
  • WHAT WOULD THE CODER USE FOR ICD-9 CODE?

21
MAMMOGRAPHY REPORT
  • Patient presents with palpable lump found during
    routine breast exam.
  • 611.72-Mass or lump in Breast
  • Mammography findings state the following
  • 2cm mass see at 2 oclock left breast
    consistent with DCIS (ductal carcinoma in-situ).
    Ultrasound guided breast biopsy recommended
  • CANT CODE THE CONSISTENT WITH

22
RADIOLOGY PROCEDURES
  • CPT 70000 series
  • MULTIPLE MODALITIES
  • MRI-Magnetic Resonance Imaging
  • CT-Computerized Tomography
  • ULTRASOUND
  • Nuclear Medicine
  • PET- Positron Emission Tomography
  • Mammography
  • Fluoroscopy
  • X-ray
  • Interventional

23
MRI-Magnetic Resonance Imaging
  • MR imaging uses a powerful magnetic field, radio
    frequency pulses and a computer to produce
    detailed pictures of organs, soft tissues, bone
    and virtually all other internal body structures.
  • MRI often uses a para-magnetic contrast material
  • Intravenously (no additional cpt code for IV.
    HCPCS code used for contrast material)
  • Example of how CPT codes designate this
  • 70551-MRI Brain without contrast
  • 70552- MRI Brain with contrast
  • A9579 Gadolineum
  • 70553-MRI Brain without contrast followed by
    contrast material and further sequences.
  • A9579 Gadolineum

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CT Computed Tomography
  • CT imaging combines special x-ray equipment with
    sophisticated computers to produce multiple
    images or pictures of the inside of the body.
    These cross-sectional images of the area being
    studied can then be examined on a computer
    monitor and provide greater clarity and reveal
    more details than regular x-ray exams.
  • CT exams are often done with Contrast Material
  • Intravenously
  • Orally (Not considered a w/ contrast exam per
    CPT)
  • Examples
  • 70490 CT Neck Soft Tissue without contrast
  • 70491 CT Neck Soft Tissue with contrast
    material (IV)
  • 70492 Ct Neck Soft Tissue without contrast
    followed by contrast material and further
    sections.
  • 74150 - CT Abdomen without contrast material
  • 74150 - CT Abdomen without contrast material
    (patient received Oral Contrast)
  • IMPORTANT TO REMEMBER-FOR CODING PURPOSES WITH
    CONTRAST CT REFERS TO INTRAVENOUS, INTRATHECAL OR
    INTRA-ARTICULAR ONLY.

26
CT Computed Tomography
  • CT Chest (apices through the level of the adrenal
    glands)
  • 71250 without contrast
  • 71260 - with contrast
  • 71270 - without contrast followed by contrast and
    further images (referred to as with/without)
  • CT Abdomen (dome of the diaphragm to the iliac
    crest )
  • 74150 without contrast
  • 74160 with contrast
  • 74170 - without contrast followed by contrast and
    further images
  • CT Pelvis (Aortic bifurcation to the symphysis
    pubis)
  • 72192 without contrast
  • 72193 with contrast
  • 72194 - without contrast followed by contrast and
    further images
  • CT Abd/Pelvis (new last year)
  • 74176 without contrast
  • 74177- with contrast
  • 74178 - without contrast followed by contrast and
    further images (any combination of with and/or
    without exams. ie. Abdomen without and pelvis
    with and without)

27
CT Computed Tomography
  • One Scan can sometimes equal multiple CPTs
  • Computed tomography was obtained from the apices
    to the symphysis pubis following the
    administration of iodinated contrast and oral
    contrast.
  • 71260 Chest with Contrast
  • 74177 Abd/Pelvis with Contrast
  • Q9967 Lo osmolar contrast material
  • Following Oral Contrast, Computed tomography was
    obtained following from the dome of the diaphragm
    thru the iliac crest without IV contrast.
    Additional images were then obtained from the
    dome of the diaphragm thru the symphysis pubis
    with the administration of iodinated IV
    contrast.

28
CT Computed Tomography
  • One Scan can sometimes equal multiple CPTs
  • Computed tomography was obtained from the apices
    to the symphysis pubis following the
    administration of iodinated contrast and oral
    contrast.
  • 71260 Chest with Contrast
  • 74177 Abd/Pelvis with Contrast
  • Q9967 Lo osmolar contrast material
  • Following Oral Contrast, Computed tomography was
    obtained following from the dome of the diaphragm
    thru the iliac crest without IV contrast.
    Additional images were then obtained from the
    dome of the diaphragm thru the symphysis pubis
    with the administration of iodinated IV
    contrast.
  • 74178 Abdomen Pelvis without following by with
    contrast
  • Q9967 Lo osmolar contrast material

29
CT Computed TomographyOften called cross
sectional imaging
30
ULTRASOUND/ULTRASONOGRAPHY
  • Ultrasound imaging involves exposing part of the
    body to high-frequency sound waves to produce
    pictures of the inside of the body. Ultrasound
    exams do not use radiation. Because ultrasound
    images are captured in real-time, they can show
    the structure and movement of the body's internal
    organs, as well as blood flowing through blood
    vessels.
  • US also had codes outside of the 70000 series
  • Non Invasive Vascular Diagnostic Studies
    93800-93990
  • These are often called Dopplers or Duplex
    Scans
  • Most common uses for US are Abdominal imaging,
    OB and Gynecological imaging and Venous/Arterial
    blood flow imaging.

31
ULTRASOUND/ULTRASONOGRAPHY
32
US-ABDOMEN
  • Dictation must mention the following 8 elements
    to be considered a full (76700) vs a limited
    (76705)
  • Upper Abd. Aorta
  • Inferior Vena Cava
  • Common Bile Duct
  • Gall Bladder
  • Kidneys
  • Liver
  • Pancreas
  • Spleen

33
US- Retroperitoneal (renal)
  • 76770 complete vs. 76775 limited
  • Complete exam consists of
  • Kidneys
  • Abd Aorta
  • Common Iliac Artery origins
  • IVC
  • UNLESS clinical history suggests Urinary Tract
    pathology then a complete evaluation of the
    Kidneys and Urinary Bladder also comprises a
    complete.

34
Ultrasonic Guidance
  • Includes guidance for
  • Pericentesis (cpt 49083)
  • Thoracentesis (cpt 32555)
  • Vascular access
  • Intrauterine fetal transfusion or cordocentesis
  • Needle placement
  • Chorionic villus sampling
  • Amniocentesis
  • Aspiration of ova

35
Nuclear Medicine
  • Nuclear medicine is a branch of medical imaging
    that uses small amounts of radioactive material
    to diagnose or treat a variety of diseases.
  • Thyroid function (endocrine)
  • 78012 Thyroid Uptake
  • A9516 Iodine-123
  • Renal (Gastrointestinal System)
  • Bone (Musculoskeletal System)
  • 78306 Bone imaging Whole Body
  • A9503 TC99M MDP
  • Heart (Cardiovascular system)
  • Brain (Nervous System)

36
PETPositron Emission Tomography
  • Positron emission tomography is a type of nuclear
    medicine imaging typically used in the diagnosis
    and staging of cancer.

37
Mammography
  • Mammography is a specific type of imaging that
    uses a low-dose x-ray system to examine breasts.
    It is used to aid in the early detection and
    diagnosis of breast diseases in women.
  • Two recent advances in mammography include
    digital mammography and computer-aided detection.
  • CPT Codes
  • 77056 Diagnostic Mammography, bilateral film
  • G0204 Diagnostic Mammography, bilateral
    digital
  • G0206 - Diagnostic Mammography, unilateral
    digital
  • 77051- Diagnostic CAD (computer aided detection)
  • 77057 Screening Mammography, film
  • G0202 Screening Mammography, digital
  • 77052 - Screening CAD

38
Fluoroscopy Xray
  • Imaging with x-rays involves exposing a part of
    the body to a small dose of radiation to produce
    pictures of the inside of the body. X-rays are
    the oldest and most frequently used form of
    medical imaging.
  • Fluoroscopy makes it possible to see internal
    organs in motion using the same technology as
    x-ray.
  • CPT Code - watch of views
  • 71020 Chest xray 2 view
  • 71010 Chest xray 1 view

39
Interventional
  • Interventional Radiology is the practice of
    Treatment of a patients condition, not just
    diagnosing it.
  • Examples of Interventional
  • CT or US guided Biopsies
  • US guided Paracentesis or Thoracentesis
  • Uterine Artery Embolizations for Uterine Fibroids
  • Pain Management Epidurals or Joint Injections
  • All I.R. will have a surgical component CPT
    code.

40
MODIFIERS
  • Radiology exams consist of two components-
  • -TC Technical component (using the machine to
    take the picture)
  • -26 Professional component (reading of the
    xray by the radiologist)
  • No modifier used if billing Global (full exam)
  • Exams done bilaterally (arms, legs etc.)
  • - RT Right
  • - LT Left
  • Exams with same CPT code for different sites
    (MRI- any jt. lower ext)
  • - 59 Distinct Procedural Svc.
  • Other common modifiers used in radiology
  • - 76 Repeat procedure by same physician
  • - 77 Repeat procedure by different physician

41
Examples of Modifier Use
  • Chest Xray done by Pediatricians office and sent
    to Radiologist to be interpreted
  • 71020-TC billed by pediatricians office
  • 71020-26 billed by radiologist
  • Chest Xray done in a Radiology Clinic
  • 71020 billed by radiology clinic
  • Right and Left Knee MRIs done at a Radiology
    Clinic
  • 73721-LT
  • 73721-RT
  • Right Knee and Right Ankle MRI done at Radiology
    clinic
  • 73721-RT
  • 73721-59, RT
  • Chest Xray upon admit to hospital and again 10
    hrs later-same day
  • 71020
  • 71020-76 if read by same radiologist OR 71020-77
    if different radiologist

42
Compliance
  • Radiology DONTS!

43
Compliance
  • Radiology DONTS!
  • IF ITS NOT IN THE WRITTEN REPORTIT DIDNT
    HAPPEN AND YOU CANT CODE IT!

44
Compliance
  • Radiology DONTS!
  • IF ITS NOT IN THE WRITTEN REPORTIT DIDNT
    HAPPEN AND YOU CANT CODE IT!
  • IF IT WASNT ORDERED BY A REFERRING
    PHYSICIAN, EVEN IF IT WAS DONE, YOU CANT BILL
    FOR IT.

45
Compliance
  • Radiology DONTS!
  • IF ITS NOT IN THE WRITTEN REPORTIT DIDNT
    HAPPEN AND YOU CANT CODE IT!
  • IF IT WASNT ORDERED BY A REFERRING
    PHYSICIAN, EVEN IF IT WAS DONE, YOU CANT BILL
    FOR IT.
  • CONFIRMED SYMPTOMS OR FINDINGS ONLY!!

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  • THANK YOU
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