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.