Ch. 16 Radiology

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what is aorotgraphy?

xray of the aorta after injection of contrast

what is xray of horizontal and vertical cross sectional views or slices of the body that are computer processed to create three-dimensional, or 3D images

computed axial tomography (CT)

noninvasive xray procedure uses an external magnetic field to produce a 2 dimensional view of an internal organ or structure such as the brain or spinal cord

(MRI) magnetic resonance imaging

xray images of the body are produced after the administration of radioisotopes, which track metabolism or blood flow, not anatomy

positron emission tomography (PET)

combined technical & professional components as reported with a CPT Radiology code

global service

Patient undergoes a complete chest xray which is performed on an outpatient basis at the hospital. The patient's primary care provider completed a requisition for the chest xray after evaluation of shortness of breath. The RT takes the xray and the radiologist interprets the image and documents an xray report. A copy is mailed to the primary provider. Who reports what?

The hospital reports the xray as a global service

The pt is seen by her primary provider who evaluates a lump on her right pinkie finger. The office has xray equipment and takes a 2 view xray of the hand. The xray is interpreted by a hand specialist who is located in another office. Who reports what?

The primary provider reports the xray code with HCPCS lev 2 modifier -TC, The hand specialist reports the xray code with CPT modifier -26

Patient underwent ultrasound exam of the swollen tonsils, (Code 76536 is reported for the 'ultrasound, soft tissues of the head/neck real time w/ image documentation').what is reported

because just the tonsillar tissue was evaluated code 76536 is reported with modifier -52

A patient presents to the ED with blunt abdominal trauma. complete acute abdomen series with supine, erect and decubitus views & single view chest xray was performed. The pt became unstable several hours later in the ED, and the xray was repeated. Do you report the xray 2x?

yes, report 74022 twice and add -76 to the second one

what modifier isnt usually added to radiology codes?

modifier -51 (multiple procedures)

When the radiologist provides E/M services as part of the radiographic procedure, do you report both?

no, the services provided by the radiologist include a minimal history and exam, unless the E/M is significantly separate and distinct from the radiographic procedure

The pt's primary provider requests that a radiologist provide consultation services to render an opinion about the pt's candidacy for a uterine emboliztion procedure. The raiologist performs a comprehensive history and exam and reviews the pt's record. A pelvic MRI is performed to assist in medical decision making. What is reported?

radiologist report a code from the Consultations category of E/M section

Contrast studies that require injection of contrast are called?

interventional because they are considered invasive

are used to diagnose and treat conditions using percutaneous or minimally invasive techniques under imaging guidance, are considered invasive procedures

interventional radiologic procedures

When you see the term "radiological supervision and interpretation" that means the radiologic service was a part of a component...?

component coding; which allows for reporting a radiology procedure and a surgical procedure code to completely describe the service provided

In a hospital outpt setting, a radiologist performed an injection procedure and supervised and interpreted an antegrade pyelography thru a previously placed nephrostomy. What is reported?

The hospital reports codes 50394 (surgery for antegrade pyelography injection) and 74425 (radiologic supv/interp. of antegrade pyelography

When contrast material is administered _______ or _______ the administration of the contrast is not reported separately. It is included in the radiologic procedure performed

orally; rectally

The supply of contrast material, should be reported with?

HCPCS level 2 codes

When radiographic procedures are repeated during the same encounter due to substandard quality, do you report the repeat?

no just one one code

If after reviewing initial films the radiologist elects to obtain additional views to render further interpretation, do you report the extra views?

generally its included in the one code check with 3rd party payer's policy regarding multiple procedures

Descriptions of many radiology codes refer to a "minimum" number of views. When more than the minimum number specified in the code description is performed and a more specific code is not available, what do you report?

report 1 code for the highest level of service

The pt presented to the ED with the complaint of severe shortness of breath. A single view, frontal, chest x-ray was obtained. A repeat chest xray, complete (minimum of 4 views) was obtained several hours later after it was noted that the pt was experiencing labored breathing unrelieved by meds, what do you report?

report codes for the single and the complete chest xray add modifier -59 to second xray

Are preliminary scout radiographs (obtained prior to contrast administration), reported separately?

yes when there is a CPT code available to classify scout radiographs, if not then its included in the code for the primary procedure

According to CPT Assistant when radiographic supv & interp. are performed during surgical procedures__________ is included in the radiologic procedure code.

fluoroscopy

refers to the fluid filled space btwn the layers of the tissue that cover the brain/spinal cord

intrathecal

Patient underwent CT of the cervical spine with IV injection of contrast material, Report?

72126

***Paient underwent CT of the thoracic spine with intrathecal injection of contrast, Report?

72129 and 62284

Patient underwent cystography (3views) whcih involved insertion of a catheter thru the pt's urethra into the bladder and injection of contrast material, x-rays were taken from various angles at various stages of filling to visualize the bladder, do you report for the insertion of catheter & injection of contrast?

Report 74430 (cystography) and 51600 (cystography,injection). Do not report for catheter insertion. [For urologic procedures and other surgeries, the insertion of a urethral catheter is included in the radiologic procedure & not separately reported. However, a code for the injection procedure to administer dye or radionuclide material is reported]

Less invasive technique that uses cray beams to image blood vessels?

computed tomographic angiography (CTA)

What is the key distinction between CTA and CT?

CTA includes reconstruction post-processing of angiographic images and interpretation, if reconstruction post-processing is not performed, the procedure is not a CTA study

What is epidurography?

performed to assess the structure of the spine's epidural space prior to percutaneous epidural adhesiolysis (identify nerve construction/inflammation and the degree of fluid flow in the epidural space)

When epiduography is performed at multiple spinal levels do you report for each level?

report 72275 for each spinal region examined (ie once for the thoracic region, once for lumbar)

what makes nonselective vascular catheterization different from selective catheterization?

nonselective is only the introduction of the catheter into a 1st order vessel; selective is the insertion & manipulation of catheter for diagnostic/therapeutic purposes

The introduction of a catheter into the femoral artery and threading of the catheter into the aorta is?

a nonselective vascular catheterization procedure

A nonselective vascular catheterization code from the Surgery section is not reported with?

a selective radiological supervision and interpretation code

Patient underwent outpt bilateral carotid arteriograms. Catheter was inserted into right common femoral artery, advanced to aortic arch, inserted into left carotid artery, and contrast material was injected. Catheter was withdrawn from left carotid artery, advanced to brachiocephalic artery, inserted into right carotid artery, and contrast material was injected. Bilateral carotid arteriograms were performed. What is reported?

Report 36215-LT (first order branch), 36218-RT (add on 3rd order & beyond brachiocephalic), 75680 (bilateral carotid arteriogram)

arteriogram is also known as?

angiography

what is all a part of the axial skeleton?

hips, pelvis, or spine

what is all a part of the appendicular skeleton?

peripheral bones such as wrist or heel; vertebra

what is biomicroscopy?

an ultrasound display mode; optical instrument looks like microscope

What is corneal pachymetry?

noninvasive ultrasound procedure that determines thickness of the cornea

To report a code for a "complete ultrasound", the documented report must contain?

a description of all elements or the reason that an element could not be visualized

A "complete ultrasound" includes?

visualization and diagnostic evaluation of all major structures within the anatomic location

Patient underwent a transvaginal ultrasound to confirm ectopic pregnancy, Is this a limited or complete?

the procedure is limited because a "complete" transvaginal ultrasound involved evaluation of the uterus, endometrium, adnexae, and ovaries.

Doppler ultrasound allows for real-time viewing of ______ _____ which cannot be obtained by other methods.

blood flow

Patient underwent ultrasound guidance for pericardiocentesis during the same encounter, what do you report?

report 33010 (pericardiocentesis) and 76930 (guidance for pericardiocentesis)

when there is no corresponding limited ultrasound procedure code for a complete procedure and limited ultrasound was done add?

modifier -52 (reduced services)

A 75 year old pt. underwent fluoroscopic guidance for visualization of the subclavian vein during placement of a nontunneled central venous catheter. Report codes 36556 and 77001 (Do not report -51 with add on code 77001). Besides looking at the notes above the code for the CVC how do you find the fluoroscopy code ?

INDEX: FLUOROSCOPY, VENOUS ACCESS DEVICE

The specialty of medicine that uitlizes high-energy ionizing radiation in the treatment of malignant neoplasm and certain non malignant conditions?

radiation oncology

what are modalities of radiation oncology?

brachytherapy, hyperthermia, stereotactic radiation, and teletherapy

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