RADIOLOGY CODING BASICS

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RADIOLOGY CODING BASICS

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

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What is an RCC?
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What is an RCC?
REAL COOL CODER?
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What is an RCC?
REAL COOL CODER?
REALLY CRAZY CHICK?
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What is an RCC?
REAL COOL CODER?
REALLY CRAZY CHICK?
RADIOLOGY CERTIFIED CODER!!!!
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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.

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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.

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What Makes Radiology Coding so Different?

• Its subjective
• After all its a PHOTO
• Photos are hard to diagnoseRight?

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What Makes Radiology Coding so Different?

• Its subjective

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What Makes Radiology Coding so Different?

• Its subjective

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What Makes Radiology Coding so Different?

• Its subjective

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What Makes Radiology Coding so Different?

• Its subjective

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PHOTOS ARE SUBJECTIVE

• Appears to be
• Consistent with
• Similar to
• Suggestive of
• NOT CODEABLE LANGUAGE

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Some things are Obvious!
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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

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WHATS CODEABLE??

• ABDOMINAL ULTRASOUND IS ORDERED

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WHATS CODEABLE??

• ABDOMINAL ULTRASOUND IS ORDERED
• Reason for Visit
• Rule-out Hernia

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WHATS CODEABLE??

• ABDOMINAL ULTRASOUND IS ORDERED
• Reason for Visit
• Rule-out Hernia
• Findings
• No Hernia Found

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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????

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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?

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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

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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

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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.

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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)

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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.

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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

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CT Computed TomographyOften called cross
sectional imaging
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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.

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ULTRASOUND/ULTRASONOGRAPHY
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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

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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.

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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

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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)

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PETPositron Emission Tomography

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

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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

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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

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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.

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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

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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

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Compliance

• Radiology DONTS!

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Compliance

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

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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.

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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