radiology-CPT GUIDELINES BY BHARATH KUMAR MEDESUN STUDENT

1. RADIOLOGY

2. INTRODUCTION
• Radiology is a specialty that uses medical imaging to diagnose
and treat diseases seen within the body.
• A variety of imaging techniques such as X-ray radiography,
ultrasound, computed tomography (CT), nuclear medicine
including positron emission tomography (PET), and magnetic
resonance imaging (MRI) are used to diagnose and/or treat
diseases.

3. • Radiography is an imaging technique using X-rays to view the
internal structure of an object. To create the image, a beam of
X-rays, a form of electromagnetic radiation, is produced by
an X-ray generator and is projected toward the object.

4. • Ultrasound is sound waves with frequencies higher than the
upper audible limit of human hearing.
• Ultrasound is used in many different fields. Ultrasonic devices
are used to detect objects and measure distances. Ultrasound
imaging or sonography is often used in medicine.

5. • CT scan makes use of computer-processed combinations of
many X-ray images taken from different angles to produce
cross-sectional (tomographic) images (virtual "slices") of
specific areas of a scanned object, allowing the user to see
inside the object without cutting.
• Other names include computed axial tomography (CAT scan)
and computer aided tomography.

6. • Magnetic resonance imaging (MRI) is a medical
imaging technique used in radiology to form pictures of
the anatomy and the physiological processes of the body in
both health and disease.
• MRI scanners use strong magnetic fields, radio waves,
and field gradients to generate images of the organs in the
body.

7. CPT GUIDELINES
• Procedures in the radiology chapter performed using with
contrast or without contrast.
• To perform a procedure various imaging techniques are used,
code are arranged based upon the type of technique.

8. • Neurofunctional tests are administered by a technologist or
other non-physician or non-psychologist,use 70554
• Neurofunctional tests are administered by a physician or
psychologist,use 70555

9. • Cardiac MRI for velocity flow mapping can be reported in
conjugation with 75557,75559,75561 or 75563.
• Only one add-on-code for flow velocity can be reported per
session.

10. • Two types of cardiac MRI tests will be performed
a. During rest
b. During pharmacological stress,therefore appropriate stress
testing code from the 93015-93018 series should be
reported in addition to 75559-75563.

11. VASCULAR PROCEDURES
• Selective vascular catheterizations should be coded to include
all lesser order selective catheterizations used in the
approach.
• Catheterization codes are not additionally reported for
diagnostic lower extremity angiography when performed
through the same access site as therapy performed in same
session

12. • If a different arterial puncture site is necessary report
separately.
• Diagnostic angiography codes should not be used with
interventional procedures
• Diagnostic angiography is performed along with interventional
procedures append modifier-59

13. • Diagnostic angiography is not reported separately when it
included in the interventional code.
• Same like above diagnostic venography is not reported
separately when it included in the interventional code.

14. TRANSCATHETER
PROCEDURES
• Unless specifically included in the coder descriptor,diagnostic
angiography is performed at the time of transcatheter
procedures,is separately reportable.

15. DIAGNOSTIC ULTRASOUND
• Use of ultrasound,without thorough evaluation of organs or
anatomic region,image documentation and final written
report is not separately reportable.
• A-mode implies a one-dimensional ultrasonic measurement
procedure.

16. • M-mode implies a one-dimentional ultrasonic measurement
procedure with movement of the trace for recording.
• B-scan implies a 2-dimentional ultrasonic scanning procedure
with a two dimentional display.

17. • Real-time scan implies a two dimensional ultrasonic scanning
procedure with display of both structure and motion with
time.
• For spectral and color doppler evaluation of the
extremities,use 93925,93926,93930,93931,93970 or 93971 as
appropriate.

18. • Do not report guidance codes for services in which
fluoroscopic guidance is included in the descriptor.

19. RADIATION ONCOLOGY
• Radiation oncology provide for teletherapy and brachytherapy
to include initial consultation,clinical treatment
planning,simulation,medical radiation
physics,dosimetry,treatment devices,special services and
clinical treatment management procedures.
• They include normal follow-up care during course of
treatment and for 3 months following its completion.

20. CLINICAL TREATMENT
PLANNING
• It is a complex process services including interpretation of
special testing tumor localization,treatment volume
determination time,choice of treatment
modality,determination of number of size and ports selection
of appropriate treatment devices,and other procedures.

21. Continued……….
• Simple planning requires a single treatment area of interest
encompassed in a single port or simple parallel opposed ports
with simple or no blocking.
• Intermediate planning requires 3 or more converging ports,2
separate treatment areas,multiple blocks or special time dose
constraints.

22. • Complex planning requires highly complex blocking,custom
shielding blocks,tangenital ports,special wedges or
compensators,3 or more separate treatment areas,rotational
or special beam considerations combination of therapeutic
modalities.

23. SIMULATION
• Simulation is the process of defining relevant normal and
abnormal target anatomy and acquiring the images and data
necessary to develop the optimal radiation treatment process
for the patient.

24. • Simple simulation of a single treatment area
• Intermediate simulation two separate treatment areas
• Complex three or more treatment areas.

25. RADIATION TREATMENT
DELIVERY
• Number of alternative methods to deliver external radiation
treatments which are described below
• X-ray
• Electron beam
• Neutron beams
• Proton beams

26. Radiation treatment and
management
• Simple:single treatment area,one or two ports,and two or
fewer simple blocks.
• Intermediate:2 separate treatment areas,3 or more ports on a
single treatment area,or 3 or more simple blocks
• Complex:3 or more separate treatment areas,custom
blocking,tangenital ports,wedges field on field that does not
meet IMRT guidelines

27. RADIATION TREATMENT
MANAGEMENT
• It is reported in units of five fractions or treatment
sessions,regardless of the actual time period in which the
services are furnished.
• Services need not be furnished on consecutive days.
• Multiple fractions representing 2 or more treatment sessions
furnished on the same day reported separately

28. • 77427 is also reported for 3 or 4 fractions beyond a multiple of
5 at the end of a course of treatment
• 1 or 2 fractions beyond a multiple of 5 at the end of a course
of treatment are not reported separately.

29. • 77469 is includes only intraoperative sessioj management and
does not include outside of that session.
• Professional services includes like
• Review of port images
• Review of dosimetry,dose delivery,and treatment parameters
• Review of patient treatment set-up

30. PROTON BEAM TREATMENT
DELIVERY
• Simple proton treatment delivery to a single treatment area
utilizing a single port.
• Intermediate proton treatment delivery to one or more
treatment areas using two or more ports or one or more
tangenital ports
• complex proton treatment delivery to one or more treatment
areas using two or more ports per treatment area with
matching or patching multiple isocenters,with custom blocks
and compensators

31. • Hyperthermia treatment given concurrently with radiation
therapy is listed separately.
• Hyperthermia is used only as an adjunct to radiation therapy
or chemotherapy
• Preliminary consultation is not included(E/M CODES)

32. • 0394T,0395T to report high dose rate electronic
brachytherapy.
• Modifiers of radiology chapter consist professional component
modifier and technical component as appropriate.
• Without modifier of radiology code considered as global code
• With modifier is considered as component code

33. RANGE OF CODE
• Code range for radiology(70010-79999)
• Modifier-26 for supervision and interpratation of clinical data
• Modifier-TC for technical component
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34. THANK YOU