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Chapter 17 Radiology

Terms in this set (202)

Anatomic position
Erect, facing forward, arms rotated outward with palms facing forward, hands open with thumbs pointed out. the feet are together or slightly apart.
Supine position
Lying down on the back with the face up. This position is also known as dorsal recumbent (lying down).
Prone postion
Lying face down on the front of the body. also known as ventral recumbent.
Lateral Position
Position in which the side of the subject is next to the film. This can be performed as erect lateral (standing side) or lateral decubitus (lying down side).
Oblique position
Slanted position where the patient is lying at an angle neither prone nor supine. In radiology, you may see right anterior oblique (RAO), left anterior oblique (LAO), right posterior oblique (RPO), or left posterior oblique (LPO). the anterior or posterior terminology indicates the part of the body closer to the film. For example, in RAO, a person is on his right side, with the anterior part of the body closer to the film.
Anteroposterior (AP)
The X-ray beam enters the front of the body (anterior) and exits the back of the body (posterior).
Posteroanterior (PA)
The X-ray beam enters the back of the body (posterior) and exits the front of the body (anterior).
Lateral
The X-ray beam enters one side of the body and exits the other side. Lateral projections are named by the side of the body placed next to the film.
Oblique
The X-ray beam enters at an angle neither frontal (AP or PA) or lateral.
Radiology
Branch of medicine that using radiation - including ionizing radiation, radionuclides, nuclear magnetic resonance, and ultrasound- to diagnose and treat disease.
Planes
ways in which the body can be divided.
Most common planes
-Frontal (coronal) plane -cutting the body into front (anterior) and back (posterior) halves
-Sagittal plane - cutting the body into right and left portions
-Transverse (axial) (horizontal) plane - Cutting the body into upper (superior) and lower (inferior) halves.
-Midsagittal plane - divides the body into equal portions of right and left.
Radiological projections
Refers to the path in which the X-ray beam flows through the body. Common projections include:
Anteroposterior (AP), Posteroanterior (PA), Lateral, and Oblique
frontal
refers to the front or anterior portion of the
body
dorsal
refers to the back or posterior portion of the body.
Superior
refers to the top of the body or above
Inferior or Caudal
means the bottom of the body or below
Lateral
to the side, so your arms are lateral to your midline
Medial
means toward the middle, so your abdomen is medial to your arms.
Supine
is facing up
prone
facing down
Erect
is standing up
Decubitus
is lying down
Oblique projection
which is where the body is at a slanted position; it does not face frontal or lateral, but at an angle.
Lateral projection
when referring to the projection refers to the X-ray beam traveling through the side of the body.
Anteroposterior projection
is when the projection is from front to back, or anterior to posterior
Posteroanterior projection
is when the projection is from back to front, or posterior to anterior
cone view
is a focused or spot view
proximal
which is closer to the point of attachment to the body. For instance, the elbow is proximal to the wrist because the shoulder is the attachment of the limb to the body, and the elbow is closer to the shoulder than the wrist.
Distal
is away from the point of attachment; therefore, the wrist is distal to the elbow. That is to say, the wrist is further from the shoulder (which is our point of attachment) than the elbow.
Flexion
is the bending of a joint to reduce the angle of the joint.
Extension
is straightening the joint which increases the angle of the joint.
Medical necessity
Each procedure ordered and performed must be validated by medical necessity. It is best illustrated by a solid, accurate, and specific diagnosis.
Diagnosis
Must reflect a sign, symptom, condition, or injury. In the case of a screening film, a V code diagnosis is used to indicate what problem is under surveillance or screening.
How to code routine screening
A radiology service can be performed as routine, screening, or for a sign or symptom. A routine screening might be performed with a preventative medicine exam, such as a routine chest X-ray. If a chest X-ray is performed as part of a preventative exam, it is coded with V72.5 Radiological examination, not elsewhere classified.
What are screening exams
They are used when there are no signs or symptoms, but the provider is looking for a specific disease or illness. EX: mammography or bone density study ( V76.11 V76.12 for mammography).
Another type of screening is when a patient requires clearance for surgery. X-ray is performed as part of pre-op exam, V72.81-72.84
How to code when a test is ordered for sign or symptom but the outcome is a normal result and no diagnosis confirmation
Coder reports the signs or symptoms prompting the physician to order the test.
For patients receiving diagnostic services only during an encounter/visit:
Sequence first the diagnosis, condition, problem, or other reason for encounter/ visit shown in the medical record to be chiefly responsible for the outpatient services provided during the encounter/visit. Codes for other diagnoses (eg. chronic conditions) may be sequenced as additional diagnoses.
For encounters for routine laboratory/radiology testing in the absence of any signs, symptoms, or associated diagnosis:
Assign V72.5 and/or a code from subcategory V72.6. If routine testing is performed during the same encounter as a test to evaluate a sign, symptom, or diagnosis, it is appropriate to assign both the V code and the code describing the reason for the non-routine test.
For outpatient encounters for diagnostic tests that have been interpreted by a physician, and the final report is available at the the time of coding:
Code any confirmed or definitive diagnoses documented in the interpretation. Do not code related signs and symptoms as additional diagnoses.
When documenting orders from the treating practioner, an order may include the following forms of communication:
-A written document signed by the treating physician/practitioner, which is hand delivered, mailed, or faxed to the testing facility;
-A telephone call by the treating physician/practioner or his or her office to the testing facility; or
-An e-mail by the treating physician/practioner or their office to the testing facility.
Written interpretation
Once the written interpretation is dictated and typed, there can be no alterations to the report for billing or coding purposes.
"Separate Procedure"
These procedures may be performed as an integral part to another procedure or alone. Should only be coded if performed alone or performed with an unrelated service.
There are very few " separate procedures" codes in Radiology section.
"Unlisted Service" codes and reporting
Anytime an unlisted service code is reported, the claim should be accompanied by a special report describing the procedure and the reason the procedure was medically necessary. You will also want to explain the equipment, time, and effort involved.
Angiography
Radiograph if image of the blood vessels, using contrast material.
Aortography
Radiographic image of the aorta and branches, using contrast material.
Artherectomy
To remove plaque from an artery.
Brachytherapy
Radiation placed in or near a tumor within the body. Catheters, needles, seeds, wires mat be used.
Bronchography
Radiographic image of the bronchi of the lungs, using contrast material.
Cephalogram
Radiographic image of the head.
Cholangiography
Radiographic image of the bile duct
Cineradiography
Radiography of an organ in motion, (ex. A beating heart).
Colonography
Radiographic image of the (interior) colon.
Computed Tomography (CT)
Using specialized equipment, two-dimensional X-ray images are taken around a single axis of rotation. The images are combined to create a 3D image or pictures of the inside of the body. These cross sectional images of the area being studied may be examined on a computer monitor, printed or transferred to a CD.
Corpora cavernosography
Radiographic image of the corpora cavernous a and draining vines using contrast medium.
Cystography
Radiographic image of the bladder.
Dacryocystography
Radiographic image of the lacrimal drainage system.
Discography
Radiographic image of the disc of the spine.
Doppler
A type of ultra sound,especially useful for imaging blood flow. The Doppler can create images either in shades of gray or, when processed by a computer, in color.
Dual-energy X-ray Absorptiometry (DEXA/DXA)
Test performed to determine bone density.
Ductogram
Imaging of the ducts of the breast.
Duodenography
Radiographic examination of the duodenum and pancreas.
Echocardiography
Ultrasound image of the brain.
Epidurography
Imaging of the epidural space in the spine.
Fluoroscopy
A continuous X-ray image, used to view the movement of a body part, or of an instrument or dye moving through the body.
Hyperthermia
A type of cancer treatment in which the tissue is exposed to high temperatures (up to 113*F).
Hysterosalpingography
Fluoroscopic imaging (with contrast) of the uterus and Fallopian tubes.
Intraluminal
Within he lumen
Laryngography
Radiographic image of the larynx
Lymphangiography
Diagnostic imaging to view lymphatic circulation and lymph nodes; utilizes X-ray technology and the injection of a contrast agent.
Magnetic resonance
Magnetic fields align the protons within the body to produce image "slices" which are combined to produce 3-D images, may be viewed from different angles; performed either with or without contrast.
Myelography
Radio graphic image of the spinal cord.
Nephrotomography
CT image of the kidneys.
Orthopantogram
Panoramic, radio graphic image of the entire dentition, alveolar bone, and other adjacent structures on a single film; taken extra-orally.
Pachymetry
Measurement of corneal thickness.
Pancreatography
Radio graphic image of the pancreatic ducts following injection of radio plaque material.
Pelvimetry
Measurement of the dimensions and the capacity of the pelvis.
Positron Emission Computed Tomography (PET)
Nuclear imaging assessing the level of metabolic activity and perfusion in various organ systems of the body.
Portography
X-ray visualization of the portal circulation, using radiopaque material.
Pyelography
Radiographic imaging of the renal pelvis of a kidney following injection of a radiopaque substance through the ureter or into a vein.
Shuntogram
Placement of a radioactive isotope in the shunt reservoir in the head to measure the speed with which it moves to the abdomen. Shuntogram is the term used for angiography of an A/V fistula of renal dialysis.
Sialography
Radio graphic image of the salivary ducts and glands.
Single Proton Emission Computed Tomography (SPECT)
Nuclear imaging using radioactive tracers to show how blood flows to organs and tissues.
Sonohysterography
Ultrasound imaging of the uterus
Splenoportography
Radiography of the splenic and portal veins; includes injection of a radiopaque medium.
Teletherapy
Any treatment where the source of the therapeutic agent (for , instance, radiation) is at a distance from the body.
Transcatheter
Performed via the lumen of a catheter.
Ultrasound
High frequency sound waves are used to produce 2D images in examining structures inside the body or for detecting abnormalities.
Urethrocystography
Radiography of the urethra and bladder using a radiopaque substance.
Urography
Imaging of the kidneys, ureters, or bladder.
Vasography
Radio graphic image of the vas deferens and ejaculatory duct following dye injection.
Velocity Flow Mapping
A non-invasive method to image blood flow through the heart by displaying flow data on the 2D echocardiographic image
Venography
A radio graphic image of the veins following injection of contrast dye.
Xeroradiography
Creation of radiographs by photoelectric process, using metal plates coated with a semiconductor (for instance, selenium).
What are S&I codes
They describe the supervision and interpretation of a radiological procedure. Interventional radiologic procedures are used to diagnosis and treat conditions using invasive procedures. Common procedures containing S&I component include vascular procedures performed on the veins and arteries.
When a procedure requires radiological guidance:
A code from the surgery or medicine section may be reported along with the supervision and interpretation code from the radiology section.
What is reported if the same physician provides both the surgical and the radiological guidance
Both codes (surgical and radiological)
What is reported if a physician performs surgery and radiologist performs the S&I
Each will report the code for their portion of the service.
Note: The radiologist billing the S&I must be present at the time of the procedure to bill the S&I code and provide a written report.
Can radiology S&I codes be reported with modifiers 26 or TC
Yes,
What is contrast material
A substance or material that "lights up" the structure being studied so it can be visualized.
What 3 ways does "with contrast" represent contrast material being administered
Intravascularly-using a vein or artery
Intra-articularly -in a joint
Intrathecally-within a sheath, or within the subarachnoid or cerebral spinal fluid.
What methods of contrast administration does not qualify as "with contrast"
Oral and/or rectal contrast administration alone does not qualify as a study.
Oral contrast is either barium or a mixture of fruit juice and an iodine-containing liquid. Or the patient may be given a barium enema.
Gadolinium
Contrast used with MRIs.
What are some contrast materials
Gadolinium is used for MRIs. Iodine (or a hypoallergenic synthetic) is used for intravenous pyelograms (IVP), CT scans, arthrograms, and angiograms.
When coding for contrast medium...
You may also need to code additional procedure. Watch parenthetical instructions to see if additional procedure, such as injection code for contrast, should be reported.
Is contrast material included in the radiological procedure
No, contrast material is not included in the radiological procedure and can be reported separately, typically with a HCPCS II code to identify substance used.
Who reports the contrast material used?
The material is reported by the facility, unless the procedure is performed in a physicians office, where the physician owns the equipment.
The radiologist's written report is what
It is the documentation for the professional component of the radiological procedure, and must be signed.
Scout films
May be performed prior to an actual imaging study with contrast or delayed imaging. These are not coded separately as they are considered part of the basic procedure.
Screening films
May be used to prediagnose or confirm a suspected condition. In some instances, they are used to detect a an undiagnosed illness or condition.
Comparison films
Sometimes ordered to define the presence of an injury or pathology.
May be ordered to pinpoint an abnormality or deformity between a normal and injured body part. Unless there is a diagnosed pathology or injury in both areas, only X-rays taken of the infected area are coded. Comparison of anatomical structures may be considered part of the physician's medical decision-making process and final diagnosis.
Diagnostic films
May be required to evaluate the extent of the presenting symptoms or conditions,or to track the progression of the patients condition or illness.
Ex, Diabetic patients or patients with poor wound healing potential, may have malunion or nonunion of a fractured bone. Careful X-ray monitoring is required to track the patients progress and customize a treatment plan relative to their healing potential.
If splinting or casting is applied to a fracture, periodic films may be required to determine healing of the bone or maintenance of accurate alignment.
Spot films
Are submitted for a radiologist's interpretation when another physician performs the radiology supervision and interpretation procedure. Radiology S&I codes require the radiologist to supervise performance of the procedure and provide a written interpretation of the procedure.
If the radiologist was not present during the performance of the procedure, then they have not fulfilled the entire criteria for assigning an S&I code. To correctly code this scenario, the radiology code is appended with a reduced service mod 52 based on the lack of direct radiologist supervision. (Even with a well-defined and carefully written interpretation, payers may not consider this service as payable.)
Portable, handheld X-ray device
A low intensity X-ray imaging device is a lightweight portable handheld instrument using a low-level isotope as its penetrating energy source.
It can picture any part of the human anatomy inserted in the space between the energy source and the viewing mechanism.
It is useful in making immediate diagnosis in isolated areas, accident scenes, sports events, and emergency rooms.
It's is also in instances where fluoroscopy would ordinarily be used: localization of foreign bodies, selected surgical procedures and the evaluation of premature or low birth weight infants.
Diagnostic imaging
Diagnostic radiology. Consists of X-rays, Mari, and CT scan studies.
Plain X-ray
Is used to diagnose and treat various problems. It is considered both a diagnostic and therapeutic tool. It is like taking a picture or snapshot of the inside of the body. The machine sends photons through the body with the film on the other side to record the images using ionizing radiation.
Bone blocks the photons and appears white on the X-ray film, making it easy to discover a fractured bone.
Contrast material also blocks the photons and shows white on the film. Structures containing air, such as lungs, appear black on X-ray images. Muscle, fat, and fluid appear as shades of gray.
CT scans
Use a series of X-rays to produce cross sectional pictures of the body. Commonly used to diagnose rumors, identify internal injuries caused by trauma, and to diagnose vascular disease.
CTA
Computerized tomographic angiography. CT scan of the blood vessels.
Multiplanar Diagnostic Imaging
MPDI. A process translating the data produced by CT scanning by providing reconstructed oblique images contributing to diagnostic information. Also known as planar image reconstruction or reformatted imaging.
MRI.
Magnetic resonance imaging. Used to diagnose conditions in ligament, or the brain, spinal cord, heart, and internal organs such as the lungs, liver, prostate, etc.
Produces "slices" of images by using a magnetic field and the protons in your body. The slices can be combined to produce 3-D images that may be viewed from different angles.
May be performed with or without contrast.
MRA
Magnetic Resonance Angiography. Is a noninvasive diagnostic test (application) for the blood vessels.
By analyzing the amount of energy released from the tissues exposed to a strong magnetic field, MRA provides images of normal and diseased blood vessels as well as visualization and quantification of blood flow through these vessels.
Phase contrast (PC) and time-of-flight (TOF) are MRA techniques.
Phase Contrast (PC)
Measures the difference between the phases of proton spins in tissue and blood and measures both the venous and arterial blood flow at any point in the cardiac cycle.
Time-of-flight (TOF)
Measures the difference between the amount magnetization of tissue and blood and provides information on the structure of blood vessels, thus indirectly indicating blood flow. 3D images can be obtained using this method.
Contrast-enhanced MRA (CE-MRA)
I invokes blood flow imaging after the patient receives an intravenous injection of a contrast agent (gadolinium).
Gadolinium
A non ionic element, is the foundation of all contrast agents currently in use. It affects the way in which tissues respond to magnetization, resulting in better visualization of structures when compared to unenhanced studies.
Unlike ionic(iodine-based) contrast agents, allergic reactions are extremely rare. Also, does not cause kidney failure as occasionally seen with ionic contrast agents.
Many of the X-ray codes mention a number of views
When a code descriptor mentions a "minimum" number of views, at least that number of views must be taken to report the code. In addition, if more views are taken, and there is no more extensive procedure code to report the additional views, only that service should be reported. Here we see an example of a Radiologic examination of the chest, complete, minimum of 4 views. If 4 views are
taken, this code is reported. If 5 views are taken, this code is still reported since there is no more extensive CPT® code.
What is Interventional Radiology
Any procedure that uses Radiological Guidance
Minimally invasive procedures for both diagnostic
and therapeutic purposes
Origins in coronary angiograms of the 1950's and
1960's
Performed by specially trained Radiologists
Methods of guidance (fluoroscopy, ultrasound, CT, Methods of guidance (fluoroscopy, ultrasound, CT,
or MRI)
Typically accesses structures through a tiny (<2mm)
nick in the skin
What is an Interventional Radiologist
Recognized medical specialty who are board-certified MD's with additional advanced training in minimally invasive targeted treatments
Combination of radiologist and surgeon Combination of radiologist and surgeon
Can provide total procedure
Uses imaging equipment such as X-rays, ultrasound, CT and MRI to guide small instruments such as
catheters or wires through the blood vessels or other
pathways to treat pathways to treat, as well as as well as, diagnose diseases diagnose diseases percutaneously
Use the surgical section of CPT that describes the
main procedure with the assistance of the
radiological technology section to code
CPT Radiology codes
• Diagnostic Radiology 70000-76499
• Diagnostic Ultrasound 76500-76999
• Radiological Guidance from 77001-77032
• Breast Mammography 77051 Breast Mammography 77051-77059
• Bone/Joint Studies from 77071-77084
Radiation Oncology • 77261-77999
• Nuclear Medicine 78000-79999
Interventional Radiology & Surgical Codes
• Mechanical Thrombectomy: 34201, 34401, 34421, 34490
• Biliary drainage: 47510, 47511, 47530
• Tube placement Cholecystostomy: 47490
• IVC Filter: 37191
• Removal of bladder stone: 47630
S&I
Many interventional services are reported with a
code from the Radiology section in addition to a
code from the Surgery section which is called a
component code or combination coding.
When 2 physicians perform the service each will
report the code identifying the component
performed
In coding Radiology you must carefully read the
radiology report to determine the extent of the
procedure before assigning CPT
Administration of contrast material
1. with contrast-does not include orally or rectally
2. without contrast
3. without contrast followed by contrast material
Interventional Radiology in action
2 CPT codes needed to report services- Surgical and Radiology
Percutaneous Biopsy
The CT scan on the left shows a pancreatic tumor
with invasion of the adj g acent structures making it
unresectable
A biopsy guided by CT scan confirms the
diagnosis and allows treatment without surgery
Code 48102, 77012-26 Bx with CT Guidance
when the word "stress" is used in cardiac imaging
it is referring to conducting the test while or after administering a pharmacologic substance to cause the heart to work harder, in effect "stressing" the heart. Cardiac MRIs are performed for physiologic evaluation
of the cardiac function.
aortography
imaging of the aorta and its branches
angiography
imaging of the vessels
Lymphangiography
is the visualization of lymphatics;
splenoportography
is when contrast is injected into the spleen to visualize the port vessel of the portal circulation, and can be used in the diagnosis of portal hypertension
venography
imaging of the veins
Digital Subtraction Angiography (DSA)
A computer-augmented form of CA (contrast angiography) obtaining digital blood flow images as contrast agent courses through a blood vessel. The computer "subtracts" bone and other tissue from the image, improving visualization of the blood vessels.
Diagnostic imaging technique applying computer technology to fluoroscopy for visualizing the same vascular structures observable with conventional angiography. Because the radiographic contrast material can be injected into a vein rather than an artery, the procedure reduces the risk to patients, and can be performed on an outpatient basis.
When coding for diagnostic radiology
Coder needs to determine the anatomic location, the type of radiology used (xray, CT, MRI), the number of views, the type of views taken, and whether contrast material was used.
Diagnostic Ultrasound
uses sound waves to visualize internal structures such as muscles, tendons, and organs. The images can then be used to measure the size, and can also be used to observe the movement and functioning of structures such as the heart, blood vessels, etc. During pregnancy, ultrasound is used to view the fetus.
Ultrasound is also used for guidance in various procedures
Different types of ultrasound
A-mode (a-scan)-amplitude mode- is one-dimensional scan typically only seen in opthalmic ultrasounds. For an A-scan, you will look straight ahead.
B-mode (b-scan)- brightness mode- two- dimensional scan. For a B-scan, you will look in many different directions
M-mode (motion mode)- is a one-dimensional scan showing the movement of a moving structure (such as the heart).
Real time scans- B-scans in motion.
3D-scans are also available
4D scans- are 3D scans in motion.
Ophthalmic Ultrasound
includes Biometric A-scan, Biomicroscopy, Quantative A-Scan, and corneal pachymetry. For an A-scan, you will look straight ahead. For a B-scan, you will look in many different directions.
biomicroscopy
a slit lamp exam, which is a low power microscope combined with a high-intensity light source that can be
focused to shine in a thin beam. This test may detect diseases such as cataracts, macular degeneration, retinal detachment, and other eye diseases.
corneal pachymetry
A test to determine corneal thickness. Topical anesthesia is required for corneal pachymetry because the probe must touch the corneal surface. A biometric study that doesn't require permanently recorded images.
In the instructions for diagnostic ultrasounds
We are instructed all diagnostic ultrasound
examinations require permanently recorded images with measurements, when such measurements are clinically indicated. For those codes whose sole diagnostic goal is a biometric measure, permanently recorded images are not required. A final, written report should be issued for inclusion in the patient's medical record.
Should a complete exam and a limited exam be reported together?
If less than the required elements for a "complete" exam are reported, the "limited" code for that
anatomic region should be used once per patient exam session. A limited exam and complete exam
should not be reported together because a limited exam is inclusive to a complete exam.
Doppler study
A type of ultrasound that can penetrate solids or liquids. It is very useful in imaging the flow of blood. It can create either shades of gray images or can also be processed
through a computer to produce a color image. The use of Doppler imaging is separately reportable EXCEPT when used alone for anatomic structure identification in conjunction with real-time ultrasound.
To report a Doppler study there must be a permanent record of the images and a written report.
What is an obstetric ultrasound
It is either a pregnant uterus ultrasound or a fetal ultrasound.
Components for pregnant ultrasound are listed within the guidelines.
Fetal ultrasounds differ according to what is being evaluated. Fetal ultrasounds include biophysical profile (BPP) examining the health of the fetus, including information on the amniotic fluid, fetal breathing, fetal tone, and gross body movements.
Fetal ultrasounds
include biophysical profile (BPP) examining the health of the fetus, including information on the amniotic fluid, fetal breathing, fetal tone, and gross body movements. Profile can be performed with or without non-stress testing.
Non-obstetrical ultrasounds
Include a transvaginal ultrasound, a sonohysterography, and nonobstetric pelvic ultrasounds.
Transvaginal ultrasound
(means through the vagina). Is used to look at the female reproductive organs - the uterus, ovaries, cervix, and vagina- to search for ovarian cysts, tumors, infection, etc.
also used in obstetrics early in pregnancy and to evaluate the cervix.
Sonohysterography
An ultrasound of the uterus.
Saline infusion sonohysterography
Occurs when sterile saline is introduced into the uterus through the cervix. Procedure is used to evaluate symptoms such as abnormal uterine bleeding, infertility, or abnormalities of the uterine lining.
Ultrasonic Guidance codes are reported:
using ultrasound to guide the provider in performing the procedure. The codes are selected based on what type of procedure is being provided, such as pericardiocentesis, vascular access, needle placement, etc. During an encounter, either a diagnostic code ultrasound or an ultrasound guidance code can be reported, but not both.
Fluoroscopy
A continuous xray displayed onto a screen for monitoring. the continuous image is used like a real-time movie to view the movement of the body part, or instrument or dye moving through the body.
Fluoroscopic guidance codes
Used for catheter insertion, needle placement, and localization of a needle or catheter.
Computed Tomography
CT. Allows for the physician to view a constant image on a screen to monitor the movements made within the body. CT-guided stereotactic localization is used to make sure radiation beams are targeting the tumor instead of surrounding tissue or other vital organs.
CT may also be used in parenchymal tissue ablation and the placement of radiation therapy fields.
CT-guided stereotactic localization
is used to make sure radiation beams are targeting the tumor instead of surrounding tissue or other vital organs.
Parenchyma
The functional tissue of an organ.
Parenchymal tissue ablation
Destruction of the parenchymal tissue containing the cancerous cells. Both CT and MR may be used for needle placement and parenchymal tissue ablation.
Mammography
An Xray of the breast using special equipment. Long standing tool for screening and diagnosing breast disease. Codes are selected based on the imaging device, procedure performed, whether it is screening or diagnostic , and whether it is unilateral or bilateral.
Screening mammogram
Often used to detect breast cancer. National Cancer Institute recommends women age 40 and above have a screening every 2 years or more frequently for those at high-risk. Screening is performed when no symptoms exist and typically takes less time than a diagnostic mammogram. Screening mammogram are always bilateral.
Diagnostic mammogram
May be unilateral or bilateral and focus on the symptom. May also be combined with software using computer algorithum analysis designed to help the radiologist interpret mammograms, when this is used it is considered computer-aided detection (CAD) and an add-on code is reported with the mammogram
Computer-aided Detection
CAD. Diagnostic mammogram combined with software using computer algorithum analysis designed to help the radiologist interpret mammograms. When used, add-on code is reported with mammogram.
How to tell the difference between screening and diagnostic mammogram
Screening is always bilateral. Diagnostic may be either unilateral or bilateral.
Digital Breast Tomosynthesis
Takes multiple images of the breast and produces a 3D image of the breast. Provide a clearer image. There are code for both unilateral and bilateral diagnostic digital breast tomosynthesis and an add-on code for screening tomosynthesis during a screening mammogram.
Ductogram or galactogram
(galacto- root meaning milk) Imaging of the ducts in the breast. Typically used to find the reason for nipple discharge.
Echoencephalography
Use of ultrasound to examine and measure internal structures of the skull and to diagnose abnormalities and disease.
DEXA
stands for Dual-energy X-ray absorptiometry and is
performed to evaluate bone density. Helps to evaluate the risk of bone fractures (*which are often the result of osteoporosis).
Bone age study
Typically is performed on children to estimate the maturity of a child's skeletal system, based on the appearance of the growth plate on the bone.
Bone length study
Used to determine discrepancies in limb length.
Osseous surveys
Radiological procedures used to detect fractures, tumors, or degenerative conditions of the bone. They are coded based on whether the service is limited or complete, or if the survey was performed on an infant.
What is Radiation Oncology
A multidisciplinary medical specialty involving physician, physicists and dosimetrists, nurses, biomedical scientists, computer scientists, radiotherapy technologists, nutritionists, and social workers.
The radiation oncology section is divided into
1)Consultation; clinical management
2) treatment planning,
3)Radiation physics and dosimetry, devices and special services
4) various treatment deliveries,
4) radiation treatment management
4) hyperthermia,
4) clinical intracavitary hyperthermia,
4) clinical brachytherapy.
The most important guideline you can highlight or underline here is the last sentence in the first paragraph, "They in and include normal follow-up care during course of treatment and for three months following its completion."
Consultaion (1)
When a patient first visits the radiation oncologist, the consultation is to determine if radiation will benefit the patient. This service is coded from appropriate E/M, medicine, or surgical codes
2) Clinical treatment planning
How the provider determines ports, blocks, and doses of radiation. Involves interpretation of special testing, tumor localization, treatment volume determination, treatment
time/dosage determination, choice of treatment modality, determination of number and size of treatment ports, selection of appropriate treatment devices, and other procedures. The selection of treatment planning is based on levels of simple, intermediate, and complex.
The second set of codes in Clinical Treatment Planning is for therapeutic radiology simulation.
Port
The place where radiation enters the body and is often marked with tattooing. Ports are the place on the body where the radiation will be aimed. The definitions of treatment planning have references to a single port, simple parallel opposed ports, converging ports, and tangential ports.
Most patients have more than one treatment port.
Blocks
Special pieces of lead designed specifically for each patient to shield healthy normal tissue from recieving the radiation allowing the radiation to focus solely on the tumor.
Simulation
The second set of codes in Clinical Treatment Planning is for therapeutic radiology simulation. Simulation is where the radiation oncologist uses imaging to plan how to direct the radiation. The simulation is selected based on the number of ports, blocks, and the use of contrast material, and 3D simulation.
Typically, the patient will lie very still on a table while the radiation oncologist determines the ports. Sometimes, it is necessary to use a body mold to keep the patient from moving during treatment. Simulation codes are selected based on the definitions in the guidelines for simple,
intermediate, complex. Contiguous anatomic sites treated with radiation therapy are included as the treatment area. Discontinuous anatomic sites treated are considered separate treatment areas.
The information gained in simulation is then sent to the Dosimetrist who determines the proper radiation dose (called dosimetry) and the Radiation Physicist who makes sure the machine delivers the right amount of radiation to the correct site in the body.
Dosimetry
Calculation of the dose of radiation.
Radiation Physicist
makes sure the machine delivers the right amount of radiation to the correct site in the body.
Radiation Treatment Management
The actual delivery of the radiation is reported by the facility. The oversight of the delivery is reported by the physician and typically consists of review of port films, review of dosimetry, dose delivery, and treatment parameters, review of patient treatment set-up, and patient visits for response to treatment, coordination of care and treatment, and review of ancillary results. It is reported in units of five fractions or treatment sessions, regardless of the actual time in which the services are furnished. In other words, the patient can come in on Monday, Tuesday, Wednesday of one week and Monday and Tuesday of the next week, and that would be reported as five treatment sessions.
Sometimes, you will have patients who might have treatments two times per day. This would be reported as two fractions per day. Radiation treatment management for five treatments is also reported if there are three or four fractions beyond a multiple of five at the end of a course of treatment; one or two fractions beyond a multiple of five at the end of a course of treatment are
not reported separately.
Stereotactic, Radiation Treatment Delivery, Neutron Beam, and Proton Beam Treatment Delivery
These treatment delivery sections are reported by the facility only. Technical Components
Stereotactic Radiation Delivery 77371-77373
Also called radiation surgery, radiosurgery, stereotactic external-beam radiation, and stereotactic surgery. It is not actual surgery but does require precise positioning by use of special equipment to deliver large radiation doses to tumors in the brain and not to normal tissue. It is also used to treat brain disorders and is being studied in the treatment of lung and other types of cancer.
Proton beam treatment delivery
Uses protons (positively charged particles) to target tumors in sensitive areas. Because of their physical makeup of protons, they release most of their energy when they hit the tumor, and do not pass beyond the tumor. Treatment used for lung, brain, and prostate tumors and tumors in pediatric patients. Code selection based on number of ports and blocks used.
Hyperthermia
is the use of heat. Hyperthermia in conjunction with
radiation therapy is currently under investigation. Some insurance policies will allow the use of only Deep hyperthermia with radiation therapy, but consider it investigational with superficial hyperthermia. Before reporting hyperthermia codes, make sure you read through the guidelines in this section.
Clinical brachytherapy
Uses radioactive material sealed in needles, seeds, wires, or catheters. The sealed radioactive material is then
placed in or near a tumor. You may also hear this referred to as internal or implant radiation therapy. Interstitial brachytherapy is when the seeds, or other sealed radioactive material, are inserted into tissue at or near the tumor site. Intracavitary brachytherapy is when it is inserted into the body with an applicator
Interstitial brachytherapy
is when the seeds, or other sealed radioactive material, are inserted into tissue at or near the tumor site.
Intracavitary brachytherapy
is when it is inserted into the body with an applicator
Remote high dose rate (HDR) afterloading brachytherapy
Involves the precise insertion of catheters into the tumor. The catheter is then connected to a remote afterloading brachytherapy unit, which delivers radiation.
Nuclear medicine
Subdivided into diagnostic and therapeutic. Is the use of small amounts of radioactive material to examine organ function and structure. Can be used to treat cancer and other medical conditions.
The radiopharmaceuticals used are not included in the coding of tests, and should be reported separately (typically using HCPCS II) by the facility.
The radiopharmaceuticals, or radiotracers, can be swallowed, inhaled,or injected into a vein. The radioactive material is detected by a gamma camera, a PET scan, or a probe.
Diagnostic radiotherapy
is the use of small amounts of radioactive material to examine organ function and structure. Some common scans performed include thyroid uptake to evaluate
thyroid function; Renal imaging to evaluate kidney abnormalities; Bone scans for diagnosing inflammatory processes such as osteomyelitis or for localization of bone tumors; Heart scans such as myocardial perfusion and cardiac blood pool imaging; and Brain scans to investigate
cerebrovascular problems.
Therapeutic nuclear medicine
when radioactive material is used to treat
cancer and other medical conditions affecting the thyroid gland.
Positron emission tomography (PET)
- Uses radiotracers that generate positron decay
- Positron decay produces two photons in two opposite directions at a time
- Use special coincidence detection circuitry to detect two photons in opposite directions simultaneously
- Capture projections on multiple directions
Noninvasive diagnostic imaging procedure assessing the level of metabolic activity and perfusion in various organ systems of the body. Is a nuclear medicine, functional imaging technique that produces a three-dimensional image of functional processes in the body.
A positron camera (tomograph) is used to produce cross sectional tomographic images, which are obtained from postitron emitting radioactive tracer substances (radiopharmaceuticals) such as 2-[F-18] Fluoro-D-Glucose (FDG, administered intravenously to the patient.
Single photon emission computed tomography (SPECT)
Use radiotracers that generate gammay decay
- Capture photons in multiple directions, similar to X-ray CT
- Uses a rotating Anger camera to obtain projection data from multiple angles
• Similar to CT, uses a rotating Anger camera to detect photons traversing paths with different directions
• Recent advances uses multiple Anger cameras (multiple heads), reducing scanning time (below 30 minutes)
• Anger cameras in SPECT must have significantly better performances than for planar scintigraphy to avoid reconstruction artifacts
Acquires information on the concentration of radionuclides introduced into the patient's body. It is useful in the diagnosis of several clinical conditions including: stress fracture, spondylosis, infection (eg, discitis), tumor (eg, osteoid osteoma), analysis of blood flow to an organ, as in the case of myocardial viability, and to differentiate ischemic heart disease from dilated cardiomyopathy.
• Planar Scintigraphy
- Use radiotracers that generate gamma decay, which generates one photon in random direction at a time
- Capture photons in one direction only, similar to X-ray, but uses emitted gamma rays from patient
- Use an Anger scintillation camera
Reporting codes for SPECT and standard planar nuclear imaging
SPECT studies represent an enhanced methodology over standard planar nuclear imaging. When a limited anatomic area is studied, there is no additional information procured by obtaining both planar and SPECT studies. While both represent medically acceptable imaging studies, when a SPECT study of a limited area is performed, a planar study is not to be reported separately.
When vascular flow studies are obtained using planar technology in addition to SPECT studies, the appropriate CPT code for the vascular flow study should be reported, not he flow, planar, and SPECT studies.
In cases where planar images must be procured because of the extent of the scanned area (eg, bone imaging), both planar and SPECT scans may be necessary and reported separately.
Single photon absorptiometry 78350
Also known as bone density study. Describes a noninvasive radiological technique that measures the absorption of the monochromatic or dichromatic photon beam by bone material. The device, which is placed directly on the patient, uses a low dose of radionuclide to measure the mass absorption efficiency of the energy released.
The exam provides a quantitative measurement of the bone mineral or cortical and trabecular bone to assess treatment response at appropriate intervals.
Dual photon absorptiometry 78351
Another bone density test. A noninvasive technique measuring absorption of a mono- or dichromatic beam by bone material in one or more sites.
This is procedure is not covered under Medicare, still considered to be in the investigation stage.
Pulmonary Perfusion Imaging
78597-79598. Report the imaging of a patient twice: one after inhalation of radioactive aerosol to determine pulmonary ventilation, and again after injection of a radioactive particulate to determine lung perfusion.
Procedure used in diagnosis of pulmonary embolism, bronchopulmonary sequestration and pulmonary trauma.
Radiolabeled monoclonal antibodies 79403
Can locate tumor cells and either kill them or deliver tumor-killing substances to them without harming normal cells. Monoclonal antibodies (mAb) of murine origin can target tumors and detect disease when labeled with radionuclides that emit gamma rays.
Enteroclysis
is an x-ray examination of the small intestine that looks at how a liquid called contrast material moves through the small intestine.
Sets with similar terms