Radiology

Radiology

•Radiology is the study of images of the human body by the use of radiant energy. 

• Types of Radiology – Diagnostic Imaging - Therapeutic Imaging 

•Diagnostic Imaging employs several different modalities, such as plain radiography, CT scanning, magnetic resonance imaging, ultrasound, and nuclear medicine, to identify the disease and other conditions within the human body. 

• Therapeutic imaging, commonly called interventional radiology, is a subspecialty that involves the use of imaging technology to carry out minimally invasive procedures with the help of devices such as catheters, balloons, and stents to open blocked blood vessels, drain fluid, and perform needle biopsies.

RADIOLOGY SECTION

• Has 7 subsections
– Diagnostic Radiology 70000 – 76499
– Diagnostic Ultrasound 76500 – 76999
– Radiologic Guidance 77001 – 77032
– Breast, Mammography 77051 – 77059
– Bone/Joint Studies 77071 – 77084
– Radiation Oncology 77261 – 77999
– Nuclear Medicine 78000 – 79999
•Organized by the method or type of radiology and the purpose of the service.
– Subdivided by anatomical site & type of service

Technique for Radiographs

Radiography is the process of creating images by exposing an image receptor to X-rays. The resulting picture details the internal structure of the area penetrated by the X-rays. X-rays are especially useful for
examination of the skeletal system, but have limited use for diagnosis of disease processes in the soft tissues.
• Contrast technique can be used with X-rays.

• Radiographs are coded based on the number of views taken.

• 1. A single view can be taken using series of images or films. Therefore, images and films are not considered as views.
• 2.When the number of views is not mentioned, the least view of the particular region is coded.
• 3.Radiographs can be taken inside an operative room which is called fluoroscopic images.

Digital X-Ray Head and Neck

• The description of the code has to match with the document.
• Eg. Temporomandibular joints were x-rayed in close and open mouth
techniques.
• Code 70330.
• The coder has to read through the document for the region studied.
• Eg.
• Tonsil x-rays were done.
• Code 70360.
• Water views of the face are considered as sinus x-rays and not face x-rays.

    

Digital X-Ray Chest and Ribs

Chest X-rays are covered by Medicare only when they are medically necessary for the treatment/diagnosis of the patient’s condition. Several Medicare carriers have published the following statement regarding the propriety of billing for a pre-operative chest X-ray: “First, Medicare does not pay for any Preop screening services even though it may be good medicine and the hospital and/or anesthesiologist require it. However, a patient with an existing diagnosis, symptom, or complaint to justify a chest X-ray or other medically necessary services would have the service paid. Even though a problem is detected in the screening chest X-ray which would otherwise support the service, the original purpose of the X-ray was screening, therefore, it’s not covered. However, future X-rays for a medically necessary diagnosis would be covered.” Check with your carriers to determine their position on this issue.

Digital X-Ray Chest and Ribs

• The chest x-ray is always done in inspiration. Therefore when it is done in
expiration it is called a special view.
• Apical Lordotic view
• Oblique view
• Bucky studies
• Decubitus views-where RT/LT can be used.

Digital X-Ray Spine and pelvis

Code 72082 when skull, cervical, thoracic, lumbar regions are studied with two or three views.

Code 72020 for any region spine(cervical, thoracic, lumbar).72020 is the least view code for all regions of the spine.

Code 72052 when: Radiologic examination, spine, cervical; 6 or more views
4 views +oblique + flexion views
4 views +oblique + extension views
4 views +oblique + extension views +flexion views
4 views + flexion views –code 72050 and not 72052

Code 72114 when: Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views.

AP+Lateral+oblique+flexion+extension views of lumbar spine is done
AP+Lateral+oblique+flexion-code 72110 and not 72114

Digital X-Ray Spine and pelvis

• Oblique view in the spine is considered as two views.
• Eg.
• Oblique view of the thoracic spine.
• 72070
• Two Oblique views of wrist-73100
• Oblique view of wrist-73100
• Images and films are not views.
• Eg.
• 4 views of thoracic spine-72074
• 4 images of the thoracic spine-either 72020 or 72070 are coded.

Digital X-Ray Spine and pelvis

• For the Scoliosis study, we can code the below codes based on the technique.

             72081, 72082, 72083, 72084

A scoliosis study was done in standing.
• Technique: two views of the thoracic and lumbar spine and pelvis were taken.


Digital X-Ray Spine and pelvis.

• When one view of pelvis is done, code 72170.
• When two views of coccyx and sacrum are done, we can code 72220.
• When two views of the coccyx are done, code 72220 without 52 modifiers.
• But when one view of the coccyx is done, code 72220 with 52 modifiers.

Digital X-Ray Extremities

• We can use RT, LT modifiers for upper and lower extremities except for
fingers and toes.
• We have below age (infant) specific codes.
• 73092-upper extremity
• 73592-lower extremity
• Use 59 modifiers when hands and fingers are studied by the same physician
in the same DOS.

• Code 73565 when:
• AP view of right knee + AP view of the left knee in standing is done.
• IF:
• AP view of right knee + AP view and lateral view of the left knee is done
• Code separetely.73560-RT,73560-LT
• AP view of right knee + AP view of the left knee is done not in standing.
• Code separetely.73560-RT,73560-LT

Digital X-Ray Abdomen with the chest.

Code 74022 when the document states:
Acute abdomen series, Obstruction series of the abdomen
Two views of the abdomen and one view of the chest.

Other x-ray procedures.

• Sniff Test - Sinogram

• 76000 - Fluoroscopy, up to 1 hour physician time.

• Foreign body detection nose to the rectum in child-76010.

• X-ray of surgical specimen-76098.

• Bone age studies-77072

• Bone length studies-77073

• Joint survey-77077

• Osseous survey-77074,77075,77076(infant).