Download chapter 28 radiology

CHAPTER 28
RADIOLOGY
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 1
Radiology
• Radiology: Branch of medicine that uses
______
radiant energy to diagnose and treat
patients
• Specialist in radiology: _________
Radiologist
(doctor of medicine)
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 2
Radiology Subsections
• Diagnostic Radiology
– Aorta & arteries
• Diagnostic Ultrasound
• Radiologic Guidance
• Breast, Mammography
• Bone/Joint Studies
• Radiation Oncology
– Clinical Brachytherapy
• Nuclear Medicine
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 3
Terms
• __________
Fluoroscopy views inside of body, projects
onto television screen
• Live images by which physician can view
function and structure of organ
– Example: 71034, _____
Chest x-ray with
fluoroscopy
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 4
Magnetic Resonance Imaging
• MRI uses magnetic energy to view ___
soft
tissue structures
lumbar spine canal
– Example: 72148, MRI of ______
(Cont’d…)
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 5
MRI
(…Cont’d)
Figure: 28.12
Modified from Bradley WG,
Daroff RB, Fenichel GM,
Jankovic J: Neurology in Clinical
Practice, ed 5, Philadelphia,
2008, Butterworth-Heinemann.
•
MRA—Magnetic Resonance Angiography—is application of MRI that
provides visualization of blood flow, as well as images of normal and
diseased blood vessels
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 6
Tomography or CT
• Tomography used to view single
_____ plane of
body
– Example: 70450, Tomographic scan of head
or _____
brain
(Cont’d…)
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Slide 7
CT Scan of Lung Carcinoma
(…Cont’d)
A, A patient with right hilar lung carcinoma and
mediastinal adenopathy showing the margins of
the bones.
B, The scan can be set to show the soft tissue.
C, The lung organs can be shown by using
additional scan settings. There is greater detail
than would be obtained with conventional
radiographs.
(Courtesy of Bruce Porter, MD.)
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 8
Biometry
• Biometry: Application of statistical
methods to biological facts
– Example: 76516, Use of _________
ultrasound
echography in biometry of eye
• Ultrasound diagnostic non-invasive
procedures are performed to determine
composition and contours of ocular and
orbital structures
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 9
Planes of Body
• Imaginary lines
used as points of
reference
Figure: 28.1
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Slide 10
Position and Projection
• Position
_______: Way in which patient placed
Projection Path x-ray beam travels
• ________:
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Slide 11
Terminology
• Radiology uses a wide variety of terms
and abbreviations specific to planes,
positions, and projections
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Slide 12
Component Coding
• Three component terms
Professional
– __________
– Technical
________
– ______
Global
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Slide 13
Professional Component (-26)
• Physician portion of service, includes
– Supervision of ________
technician
– Interpretation
___________ of
results, including
written report
From Young AP, Proctor DB: Kinn's
The Medical Assistant, ed 10,
St. Louis, 2007, Saunders.
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 14
Technical Component (-TC)
• Technologist’s services
• Equipment, ___,
film and supplies
From Long BW, Frank ED, Ehrlich RA:
Radiography Essentials for Limited
Practice, ed 4, St. Louis, 2013, Saunders.
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 15
Global Procedure
• Both professional and technical portions of
radiology service
• If facility where procedure was performed
owns the equipment and has a radiologist
on staff who reads the report global
service
– No -TC
– No -26
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 16
Component Modifiers
• If only professional component of
-26 to
radiology service provided append ___
code
(Cont’d…)
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Slide 17
Component Modifiers
(…Cont’d)
• If only technical component was
provided append -TC
___ to code
– -TC: HCPCS modifier used with CPT and
HCPCS codes
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 18
Global Procedure
• If both professional and technical
components of radiology service provided,
use no
__ modifier
(Cont’d…)
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Slide 19
For Example: Chest X-Ray
(…Cont’d)
• Professional component:
– 71030-26 (Supervision and final report)
• Technical component:
– 71030-TC (Technician, supplies, equipment)
• Global procedure: 71030 (both professional and
technical)
(Cont’d…)
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 20
Global Procedure
(…Cont’d)
• Third-party payers usually reimburse
– 40% professional component
– 60% technical component
– 100% global procedure
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 21
Contrast Material
• Statement “with contrast” implies
_______
injection built into code
(Cont’d…)
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Slide 22
Contrast Material
(…Cont’d)
• Notes indicate codes for components
– Example: 75893, venous sampling indicates
“(For procedure, use 36500)”
• Oral or _____
rectal contrast does not qualify for
“with contrast”
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 23
Overview of Radiology Subsections
• Diagnostic Radiology
• Diagnostic Ultrasound
• Radiologic Guidance
• Breast, Mammography
• Bone/Joint Studies
• Radiation Oncology
• Nuclear Medicine
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 24
Diagnostic Radiology
• “Complete” in a code description in
radiology section, means all views taken of
specified body site
• Most standard radiographic procedures
• Codes often divided on whether contrast
material used
• Codes further divided on number
______ views
(Cont’d…)
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Slide 25
Diagnostic Radiology
(…Cont’d)
• Used to:
– Diagnose disease
– Monitor disease process—progression
or remission
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Slide 26
Diagnostic Procedures Include
• X-ray
Subdural hematoma
• Computerized
axial tomography
(CAT or CT
__ scan)
• Magnetic resonance
imaging (MRI)
From Mettler FA: Essentials of Radiology,
ed 3, Philadelphia, 2014, Saunders.
CT of renal artery
• Angiography
From Mettler FA: Essentials of Radiology,
ed 3, Philadelphia, 2014, Saunders.
From Walsh PC, editor: Campbell's
Urology, ed 8, Philadelphia, 2002,
Saunders.
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 27
Computerized Axial Tomography
• X-ray image taken in sections
• Computer reconstructs and
enhances
________ image
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Slide 28
Magnetic Resonance Imaging
• Uses magnetic fields to produce an image
displayed on computer screen
• Codes of same area (e.g., spine) divided
on whether or not _______
contrast _______
material used
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 29
Angiography
• Used to view vessel obstructions
• Dye
___ injected into vessel
(Cont’d…)
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Slide 30
Angiography
(…Cont’d)
• Angiography of
aortic arch and
brachio-cephalic
vessels
(Cont’d…)
Figure: 28.13
From Stimac GK: Introduction to Diagnostic
Imaging, Philadelphia, WB Saunders, 1992, p
447.
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 31
Angiography
(…Cont’d)
• Radiologist uses angiography to diagnose
vascular conditions
• Examples:
– Malformations
– Strokes
– Myocardial infarctions
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 32
Remember
• If fewer than total number of views
specified in code provided:
– Use -52
___, Reduced Service
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Slide 33
Diagnostic Ultrasound
• Uses high-frequency sound waves
to image anatomic structures
• Audible sound waves bounce off body
tissues and then are recorded to give
information about anatomy of an internal
organ
(Cont’d…)
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 34
Diagnostic Ultrasound
(…Cont’d)
• Ultrasound showing
a gallstone
Figure: 28.14
From Goldman L, Schafer AI, editors: Goldman's
Cecil Medicine, ed 24, Philadelphia, 2012, Saunders.
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 35
Subheadings
• Subheadings of Diagnostic Ultrasound
primarily based on anatomy
________
• Example:
– Head and Neck
– Chest
– Pelvis
• Many notes in subsection directing correct
assignment
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Slide 36
Three Locations For Ultrasound
Services
• 76506-76999: Radiology codes for
________ ultrasound services
diagnostic
• 93880-93998: Medicine codes for
vascular
_______ studies
• 93303-93352: Medicine codes for
echocardiography
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Slide 37
Interventional Radiologist
• Combination radiologist and _______
surgeon
• Provides total procedure for cystography
with contrast
– Report 74430, X-ray portion and
– 51600 for _______
injection procedure,
– Plus code for supply of contrast material
(e.g., 99070 or HCPCS code)
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 38
Ultrasound Modes and Scans
• __-mode
or A-scan technology—
A
one-dimensional
• __-mode—one-dimensional
measurement
M
procedure with movement of trace to allow
amplitude and velocity of moving echoproducing structures
• __-scan
technology—two-dimensional
B
• Real-time scan
• A & B scan may be performed together
(medical necessity documented)
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 39
A-Mode
• A = _________
Amplitude
• Technique used to map structure outline
• Displays one
___-dimensional image
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 40
M-Mode
• M = Motion
______
• Technique used to display movement of
structure
• Displays one
___-dimensional image
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 41
B-Scan
• B = Brightness
_________
• Technique used to display movement of
tissues and organs
• Known as ____
gray scale ultrasound
• Displays ___-dimensional
image
two
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 42
Real-Time Scan
• Technique used to display both _______
structure
and ______
motion with time of organ and tissues
• Displays ___-dimensional
image
two
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 43
Extent of Study
• Codes often divided on extent of study
• Example: Extent of scan as follows
(Cont’d…)
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Slide 44
Extent of Study
(…Cont’d)
• Complete: Scans entire body
• Limited: Scans part
___ of body,
i.e., one organ
• Follow-up/repeat: ______
Limited study of part of
body that was scanned previously
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 45
Radiologic Guidance, Breast, Mammography,
Bone/Joint Studies, and Radiation Oncology
• Radiologic Guidance (77001-_____)
77022
– Fluoroscopic, computed tomography, magnetic resonance
guidance, and other
77051
• Breast, Mammography (_____-77059)
– Such as screening, and computer-aided detection
• Bone/Joint Studies (77071-_____)
77084
– Such as bone density and joint survey
77261
• Radiation Oncology (_____-77799)
– Therapeutic use of radiation
– Codes for both professional and technical services
– Subheading divided based on treatment
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 46
Radiation Oncology
• Initial consultation, prior to decision to
treat, reported with E/M Consultation code
– Outpatient
________: 99241-99245
Inpatient 99251-99255
– _______:
• Follow consultation criteria: Document
who and why
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Slide 47
Clinical Treatment Planning—
Professional Component
• Includes:
– Interpretation of special testing
– Tumor localization
– Determination of treatment volume
(Cont’d…)
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 48
Clinical Treatment Planning
(…Cont’d)
• Choice of treatment method
• Determination of number of treatment
ports
• Selection of treatment devices
• Other necessary procedures
(Cont’d…)
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 49
Clinical Treatment Planning
(…Cont’d)
• Clinical Treatment Planning consists of
– Three types of treatment plans
– For all patients requiring radiation therapy
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Slide 50
Levels of Planning
(77261-77263)
• Simple
______: One treatment area, one port or
one set of parallel ports
• __________:
Intermediate Three or more ports, two
separate treatment areas, multiple
blocking
(Cont’d…)
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 51
Levels of Planning
(…Cont’d)
• Complex
_______: Complex blocking, custom
shielding blocks, tangential ports, special
wedges, or compensators, three
____ or more
treatment areas, special beams
• Unlisted procedure (77299)
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Slide 52
Simulation (77280-77293)
• Determines placement of treatment
areas/ports for radiation treatment
• Does not include administration of
_______
radiation
(Cont’d…)
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 53
Four Levels of Simulation
(…Cont’d)
• Simple
______: One treatment area with one port or pair
of ports
• __________:
Intermediate Three or more ports, two separate
treatment areas, multiple blocking
• Complex
_______: Tangential ports, three or more
treatment areas, complex blocking
• 3D: Computer generated three-dimensional
image of tumor
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 54
Medical Radiation Physics, Dosimetry, Treatment
Devices, and Special Services (77295, 7730077370)
• Decision-making services of physicians
– Treatment types
placement (dosimetry)
– Dose calculation and _________
– Development of treatment device
• Stereotactic Radiation Treatment Delivery
(77371-_____)
77373
– Pay close attention to notes
• Delivers large dose to specific tumor site
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Slide 55
Radiation Treatment Delivery
(77401-77525)
• Radiation (77401-77421)
• Neutron Beam (77422, 77423)
• Proton Beam (77520-77525)
• Technical component of actual delivery of
radiation
– MeV (electrons)
– Neutrons
– Protons
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 56
Information Needed to Code
Radiation Treatment Delivery
• Amount of radiation delivered
• Type of radiation—_______
electron (most
common), neutron, or proton
(Cont’d…)
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 57
Information Needed to Code
Radiation Treatment Delivery
(…Cont’d)
• Number of
Areas treated
– _____
(single, two, three or more)
– _____
Ports involved
(single, three or more, tangential)
– ______
Blocks used
(none, multiple, custom)
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 58
Reporting Radiation Treatment
Management (77427-77499)
• Professional (physician) portion of services,
including:
– Review port films
– Review dosimetry, dose delivery, treatment
parameters
– Treatment set-up
– Patient examination for medical E/M
– Report in units of five fractions
• Unless last 3-4 fractions are at the end of the treatment
additional fraction
– Count the last 3-4 as an ________
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 59
Clinical Brachytherapy (77750–
77799)
• Placement of radioactive material into or
around site of tumor:
– __________
Intracavitary
(within body cavity)
– ________
Interstitial
(within tissues)
(Cont’d…)
From Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB,
McKenna WG: Clinical Oncology, ed 3, Philadelphia, 2004,
Churchill Livingstone.
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 60
Source
(…Cont’d)
• Radioactive element delivers radiation
dose over time
– Examples: Seeds
_____, ribbons, or capsules
– Ribbons: Seeds embedded on tape
• Tape cut to desired length controls amount of
radiation and inserted into tissue
(Cont’d…)
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 61
Clinical Brachytherapy Codes
Divided Based On
(…Cont’d)
• Number of sources applied:
– Simple: 1_-4
– Intermediate: 5-__
10
– Complex
_______: 11+
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Slide 62
Nuclear Medicine
• Placement of radioactive material into
measurement of emissions
body and ____________
• Used both for diagnosis and treatment
– Example: Stress test
(Cont’d…)
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Slide 63
Nuclear Medicine
(…Cont’d)
• Codes divided primarily on organ system
– Exception: “Therapeutic,” for
radiopharmaceutical therapies
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Slide 64
Positron Emission Tomography (PET)
• 78811-_____
78816
PET imaging of Hodgkin’s lymphoma (the
arrows indicate the site of the disease.)
location
• Based on _______
(such as skull
base or chest)
• Non-invasive imaging
procedure that
assesses perfusion
and level of metabolic
activity in various
organ systems
From Goldman L, Schafer AI, editors: Goldman's Cecil Medicine, ed 24,
Philadelphia, 2012, Saunders.
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 65
Conclusion
CHAPTER 28
RADIOLOGY
Copyright © 2014 by Saunders, an imprint of Elsevier Inc.
Slide 66