HIT241 – Chapter 5 Part 2 Radiology (2017)
We’ll continue with our study of the Radiology Chapter in the CPT code book. This is Part 2. This part is built upon the Chapter 5 Review at the end of the Radiology Chapter in the textbook. #2- MRI of the cervical spine with contrast, MRI is performed at an independent facility that sends the images to an independent radiologist who will read and write a report of the findings. If you are coding for the radiologist, you’re going to use the -26 modifier. So in this screenshot I have shown you, I have underlined what tells you that modifier -26 is needed and you’re coding for the radiologist (that’s in green font (the last sentence in the first paragraph), the MRI of the spine. When you investigate the different code descriptions that are given in the index you select 72142 and add a modifier -26 if you’re billing for the radiologist. This is a screenshot from the code book showing you this code. This is an example, not in the textbook, that you will see on the exam for this chapter so pay attention. A patient undergoes a retrograde urethrocystography. The same physician performs both the injection and the supervision and interpretation. What’s the correct code assignment for the physician? When you read through the index you look up urethrocystography, retrograde which are the terms given in your procedure. This gives you only the injection code 51610. Remember in our Part 1 of this chapter, the Part 1 podcast, I reminded you that when you have a procedure ending in -graphy, oftentimes an injection is used to accomplish this examination and when you get to the 51610 code, you’re going to read around that, the guidelines around that code and you do find one. 74450 for radiological supervision and interpretation. You must have both codes to code this procedure. You will see this example on your exam for Radiology. Please pay attention. Here you have this particular code, also adding the guideline under it in this case, under the code, “for radiological supervision and interpretation, use this code.” (magnified) For radiological supervision and interpretation, use 74450 and this is the 74450 (code) telling you it is the urethrocystography, retrograde but only for the radiological supervision and interpretation. #4- CT scan of the abdomen with contrast and the pelvis without contrast for the same session. CT scan with and without contrast for the abdomen is 74178. I can blow this up (magnify it). When you blow it up, 74178, you notice in this family of codes at the very top, Abdomen and Pelvis, so this particular code description tells you you are coding both. The code covers both parts of the body. #6 Intracavitary placement of four radioelement sources. This example is a little tricky and I wanted to walk you through the steps of why it’s tricky and how if you are coding from an entire record, it wouldn’t be as tricky but because we are pulling phrases or sentences out of a complete record, it does get tricky when you are selecting codes. If you look at this intracavitary placement of four radioelement sources and go with radioelement as your main term, that takes you into these codes and when you look up 31643, that is a bronchoscopy code. We are coding the Radiology chapter, so what the coder would do is go back to the record to see if you can find more information that would help you select a radiology code. When you go back to the record, you would find that this intracavitary placement is being accomplished for the purpose of clinical brachytherapy so once the coder knows that from the information in the record then you would start with “brachytherapy” as your main term instead of the radioelement. I think it’s tricky for this to be in a textbook because the coder doesn’t have, the coding student doesn’t have benefit of the entire record but if you were in the field you would have benefit of the entire record to review to help you know which code families you should be looking at. When we go to the code book you see this is this family. Here it is important to note that the number of sources for the clinical brachytherapy is how you’re differentiating these codes and in this particular case, it told us “four”. Go back to the scenario here, four radio element sources so that is what’s going to drive your selection, not the first code. #8- a pelvic ultrasound pregnant uterus transvaginal. “Transvaginal” is the approach to the uterus. Transvaginal just means through the vagina, you’re getting to the uterus. You can also of course ultrasound the uterus on the outside, it’s a different approach but this particular procedure is being done transvaginally so we should have a code that describes that. When we look up all of this range of codes here from the index you do find the one that says “transvaginal”. Magnify the page, 76817 “transvaginal” is part of the code description. You notice that for both columns, at the top, I have written OB or Obstetrical because both columns, in this particular page of the CPT book, are the ultrasound of the pregnant uterus. #10-Whole body bone marrow scan. Now we’ve added, the textbook has added, in parenthesis, (Nuclear Medicine) so that you know where you’re you’re searching for codes..Without the benefit of the entire medical record , I think it’s really hard to select the right code but the authors,in this case are telling you it is in the Nuclear Medicine chapter. So if you go into “bone marrow” as your main term, nuclear medicine imaging, you get this group of codes. When we go to our codes, we’re looking for “whole body”. Blow this up and you see there is a code description 78104 for “whole body” and also know that the bone marrow falls under the Hematopoietic, Reticuloendothelial and Lymphatic System. It’s important to know, this is back to your anatomy that we’ve often talked about in this course, that your bone marrow would fall into this system., #12 Gastric emptying, imaging study also in nuclear medicine, with small bowel transit. Here’s the correct code and here it is in the code book. Let’s blow it up and you notice that one of the code description says “with small bowel transit. There is no getting away from all the reading that has to be done in this course. You have to read all these various code descriptions to select the right code and needless to say, you can’t do it quickly. Bt if you highlighted the phrases in the code families, like this, I really think it helps you find a code a lot easier. #14-a renal scan with a vascular flow and function study, without pharmacologic intervention. Main term, comes under kidney, nuclear medicine, imaging. We read those code descriptions. W get to the right one. You see I have written at the top of the Genitourinary System, in Nuclear Med Diagnostic, which just came from the previous pages in the CPT book and we do have the study “without pharmacological intervention”. The code below it is “with pharmacological intervention”. How many times in CPT, the only difference in two codes are the terms “without” and “with”. (It happens) very often. #16- myocardial perfusion or a SPECT study performed at rest. We’re just going to look at myocardial perfusion, imaging and our code tells us it is “at rest”. I’ve written at the top of the page “Cardiovascular system”. That was taken from the previous page’s far right column. #18-Ultrasound guidance for retrieval of ova. There’s your code and here it is in the code book specific to the retrieval of ova. Aspiration of ova is how it’s described. #20- Patient is known to have a mass in the temporal retina. A diagnostic opthalmic B scan ultrasound is performed along with a quantitative A scan. This is another tricky one that the authors have placed in the textbook. I just want to walk through it, explain why it’s tricky. If you strictly went by the main term “ophthalmology, diagnostic ultrasound” in this range of codes and you read through all the code descriptions in this range of codes, nothing says B scan and quantitative A scan so if you don’t find a code that matches the procedure that you are trying to code. You go back to the Index, you find other codes and if you search under “ultrasound of the eye”, you do find a different code set and one of those codes 76510 does include B scan and quantitative A scan. So if we look here in these codes, here B scan, quantitative A scan, right there. Now let’s look at some x-rays (#22) -An AP of pelvis and left hip; there’s two views that are given, one of the pelvis, one of the left hip. We’re going to assume that you’re billing for a facility that’s providing both the equipment and the radiologist but don’t forget there will be a modifier because of that “left” hip so whatever code you choose, you will have an -LT modifier to signify the left side of the body. When we look up our x-rays in the range of codes given, there are two views. The procedures tells us there’s a pelvis and left hip so 73502 would be our code, blow this up and you see the lower extremity, the x-rays are (differentiated) by “views”. We have two views so we would choose 73502. #24- this chest x-ray also two views PA view and the lateral. There is the code and here it is in the code book. Two views 71020. If you have any questions about Chapter 5 Part 2, please post them in the discussion board along with the path you used to try and find your code. I will do my best to answer them. Thank you so much and have a good day.