Transcript RADIOLOGY CODING BASICS - Silverdale WA Local AAPC

Presented by
WENDIE POND, CPC (former RCC)
Healthcare Billing and Coding Consultant
REAL COOL CODER?
REAL COOL CODER?
REALLY CRAZY CHICK?
REAL COOL CODER?
REALLY CRAZY CHICK?
RADIOLOGY CERTIFIED
CODER!!!!
RBMA-Radiology Business Management Association
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Founded in 1968, is the only radiology-specific business
organization in existence today. It’s 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.
RCCB-Radiology Coding Certification Board
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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 RCC’s in Washington
State.
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Its subjective
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After all its a PHOTO
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Photos are hard to diagnose…Right?
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Its subjective
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Its subjective
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Its subjective
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Its subjective
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“Appears to be…”
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“Consistent with…”
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“Similar to…”
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“Suggestive of…”
NOT CODEABLE LANGUAGE…
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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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ABDOMINAL ULTRASOUND IS ORDERED
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ABDOMINAL ULTRASOUND IS ORDERED
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Reason for Visit:
◦ Rule-out Hernia
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ABDOMINAL ULTRASOUND IS ORDERED
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Reason for Visit:
◦ Rule-out Hernia
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Findings:
◦ No Hernia Found
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ABDOMINAL ULTRASOUND IS ORDERED
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Reason for Visit:
◦ Rule-out Hernia
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Findings:
◦ No Hernia Found
NOTHING…THE CODER NEEDS FINDINGS or
“SYMPTOMS”. IN OTHER WORDS…WHAT IS IT THAT
MAKES THE REFERRING PHYSICIAN “THINK” THERE IS
A HERNIA????
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Patient presents with palpable lump found
during routine breast exam.
Mammography findings state the following
“2cm mass seen at 2 o’clock in the left breast
is consistent with DCIS (ductal carcinoma insitu). Ultrasound guided breast biopsy has
been scheduled.”
WHAT WOULD THE CODER USE FOR ICD-9
CODE?
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Patient presents with palpable lump found
during routine breast exam.
◦ 611.72-Mass or lump in Breast
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Mammography findings state the following
“2cm mass see at 2 o’clock left breast
consistent with DCIS (ductal carcinoma insitu). Ultrasound guided breast biopsy
recommended”
CANT CODE THE “CONSISTENT WITH…”
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CPT 70000 series**
MULTIPLE MODALITIES
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MRI-Magnetic Resonance Imaging
CT-Computerized Tomography
ULTRASOUND**
Nuclear Medicine
PET- Positron Emission Tomography
Mammography
Fluoroscopy
X-ray
Interventional
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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 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)
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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)
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IMPORTANT TO REMEMBER-FOR CODING PURPOSES “WITH CONTRAST CT
REFERS TO INTRAVENOUS, INTRATHECAL OR INTRA-ARTICULAR ONLY”.
 CT Chest (apices through the level of the adrenal glands)
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71250 – without contrast
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71260 - with contrast
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71270 - without contrast followed by contrast and further images (referred to as
with/without)
 CT Abdomen (dome of the diaphragm to the iliac crest )
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74150 – without contrast
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74160 – with contrast
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74170 - without contrast followed by contrast and further images
 CT Pelvis (Aortic bifurcation to the symphysis pubis)
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72192 – without contrast
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72193 – with contrast
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72194 - without contrast followed by contrast and further images
 CT Abd/Pelvis (new last year)
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74176 – without contrast
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74177- with contrast
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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)
One Scan can sometimes equal multiple CPT’s
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“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
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“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.”
One Scan can sometimes equal multiple CPT’s
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“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
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“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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Ultrasound imaging involves exposing part of the body to highfrequency 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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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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76770 complete vs. 76775 limited
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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.
Includes guidance for:
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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 is a branch of medical imaging that uses
small amounts of radioactive material to diagnose or treat
a variety of diseases.
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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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Positron emission tomography is a type of nuclear
medicine imaging typically used in the diagnosis
and staging of cancer.
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Mammography is a specific type of imaging that uses a low-dose xray 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:
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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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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. Xrays 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 Radiology is the practice of
“Treatment” of a patients condition, not just
diagnosing it.
Examples of Interventional:
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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.
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
- 77
Repeat procedure by same physician
Repeat procedure by different physician
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Chest Xray done by Pediatricians office and sent to Radiologist to be
interpreted
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71020-TC billed by pediatricians office
71020-26 billed by radiologist
Chest Xray done in a Radiology Clinic
◦ 71020 billed by radiology clinic
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Right and Left Knee MRI’s done at a Radiology Clinic
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Right Knee and Right Ankle MRI done at Radiology clinic
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73721-LT
73721-RT
73721-RT
73721-59, RT
Chest Xray upon admit to hospital and again 10 hrs later-same day
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71020
71020-76 if read by same radiologist OR 71020-77 if different radiologist
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Radiology DON’TS!
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Radiology DON’TS!
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IF ITS NOT IN THE WRITTEN REPORT…IT DIDN’T
HAPPEN AND YOU CANT CODE IT!
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Radiology DON’TS!
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IF ITS NOT IN THE WRITTEN REPORT…IT DIDN’T
HAPPEN AND YOU CANT CODE IT!
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IF IT WASN’T ORDERED BY A REFERRING
PHYSICIAN, EVEN IF IT WAS DONE, YOU CAN’T
BILL FOR IT.
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Radiology DON’TS!
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IF ITS NOT IN THE WRITTEN REPORT…IT DIDN’T
HAPPEN AND YOU CANT CODE IT!
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IF IT WASN’T ORDERED BY A REFERRING
PHYSICIAN, EVEN IF IT WAS DONE, YOU CAN’T
BILL FOR IT.
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CONFIRMED SYMPTOMS OR FINDINGS ONLY!!
THANK YOU