Today we're going to begin
talking about the Radiology Chapter in the CPT code book. There's
at least two podcasts. Depending upon how long they go,
it may be three. But we'll start with
Chapter 5 Part 1. These are the
subsections in the Radiology Chapter. If
you're looking at the beginning of the
chapter, these are the ones that would be
in a green font (or second level subheading) signifying the
subsections. Most of your time is going
to be spent in the first two, the X-ray
and Ultrasound but depending on where
you're coding, what setting (you are working in) you would
very well be using the other ones just
is often. The first question that you the
coder has to answer is "Who am I billing
for? The professional component only is
when the radiologist is interpreting the
report like, if you are billing for the
radiologist, you're going to bill
whatever the code is from the Radiology
Chapter with a modifier -26. If you're
billing for the facility, that is
providing only the technical component,
you're going to use a modifier -TC and if
you're billing for the facility that's
providing both the equipment and the
radiologist, you do not need a modifier.
The modifiers are different depending
upon whom you're coding for. This (slide) is
just a review of those modifiers. Also,
the payers have specific requirements so
depending on the insurance company, you will
have direction as to how they want you
to bill it. These are things that just
come with learning to code depending on
where you're working. Your orientation is
going to include helping you understand
who the most common payers are and how
we have to submit our claims. Here
examples of using those modifiers in the
ways in which we just talked about. A
radiology examination of the esophagus (is the procedure).
Images were interpreted by independent
radiologists not associated with the
facility. What code will the radiologists
report? In other words, you're the coder,
coding the radiologist's work and he or
she will code the CPT code 74220
with a -26 modifier indicating only the
radiologist's component was provided. In the
second example, you are coding for the
facility. It's the same scenario,
radiologic examination of the esophagus,
images interpreted by an independent
radiologist not associated with the
facility. What would you report if you
were coding for the facility? That
would be 74220 with a modifier -TC.
Here you see a screenshot from the
code book showing you 74220, which is an
x-ray of the esophagus. If you remember
my conventions in my code book, I circle
the families. I underline those codes that
stand alone. I highlight the significant
terms within the family or within the
code description. The super bill or the
chargemaster in our facilities do most
of this assignment for these codes, for
x-rays especially but you still need to
be aware of those conventions and if
you're on a national exam, you would have
to find the code. After graduation if
you're employed by either Radiology,
Anesthesiology or Pathology, you going to
need a lot deeper lessons for this
section of the code book. It's beyond the
scope of this class to go into it but
just be aware that if you code for
these specialties, it IS a specialty to
code for this type of provider as well
as a cardiac or cardiovascular (providers). Those are
just specialties within the field that
we all know takes a special level of
expertise to code. I want to talk a bit
more about the chargemaster so you know
more about it. The chargemaster is used for billing in all
facilities, not just CPT codes. You would
have it in your hospitals, any of your
providers. It's just a big master list of
all the charges that you can pull from
in a specific facility, The people that
are in charge of the chargemaster really
have to make sure that all the updates
each year for the ICD10 code set, CPT
and HCPCS are reflected in the
current billing software, so you'd be
sure you're pulling up the right code.
As a reminder, ICD-10 code updates
become effective October first each
year. CPT and HCPCS become effective
January first of each year. Occasionally,
you will have updates published more
frequently and that would be
communicated by whomever's making the
change but for the most part these are
the dates that you have to remember.
There are CPT codes that represent
"complete" procedures meaning everything
is done within that procedure. There's
also "limited" procedures so you have to
be sure when you're selecting your code
that you're reading those code
descriptions carefully to be sure you're
selecting the code that reflects
whatever procedure you're coding. This
example is a unilateral lymphangiography
of the extremity, with a complete
procedure. You know that the extremity
isn't specified in the documentation but
it turns out it doesn't matter because the
code is the same for both the arm and
the leg. You may recall from other
podcast as I move through these
powerpoints, I'll show the example
without the answer and then I'll show
the answer. My hope is that as you go
through these podcasts or through the
PowerPoint itself once you've printed a
PDF you would try to find your answers
before you look at them so that you're
always finding out where things are in
your code book. So here are the two codes
you would have to use for this procedure.
The first thing I'm doing is showing you
that the arm and the leg are the same
codes for the lymphangiography and then
as an instructional note in your CPT
code book that's just before the 75801
code that says "for injection
procedure for the lymphatic system, use
38790." The first thing you have to
know is that lymphangiography does
require an injection, so put that
wherever you need to put it to remember
that any time you have a (word ending in) "graphy" that
last suffix, "graphy" you're more than
likely looking at an injection to
accomplish that and then remember that
the guidelines in the CPT code book can
either be "before" or "after" a code. I wish
there were more conventions
around that like there are in the
ICD-10-CM and PCS code book but there are
not. This is how it's written so you have
to be sure you always read "above" and
"below" the code that you're selecting.
This is the 75801, a screenshot of
this code in your code book. It's in the
veins and lymphatic subsection. I've
labeled that for you at the bottom and
you also see just above the 75801
code "for injection procedure for
lymphatic system, use 38790. I blew it up.
This is the same screenshot just blown up (magnified)
a little bit so you can read it easier.
This is a screenshot of the 38750
injection procedure , lymphangiography.
It does not apply to this
scenario we are coding right now but I
just want to show you in the code below
that, I have "use with a breast code." That
is if you are doing this work to
identify the sentinel nodes. It's just a
reminder to me of how you might use that
code in a different
scenario. You notice at the top of this
column I have written what this column
is for - the lymph nodes and lymphatic
channels. That is drawn from the previous
page's subheadings and here I have blown
it up, the very same thing, just blown up.
You do notice that this code description
also tells you for a bilateral procedure
where you're injecting both sides of the
body, modifier -50 would be used. It also
tells you for the supervision and the
interpretation of this examination, you
would use these codes ,which of course we
chose in our earlier slide. Okay now
let's look at some things in the
textbook. Exercise 5.1 #2 is a
diagnostic CT scan of the colon with
and without contrast. Many times when you
look in the code where you're going to see
where something is scanned "with contrast"
"without contrast" and then it might be
"without contrast followed by "contrast".
Three different ways that that can work
for some studies not for all of them. But
this particular scenario is just a
diagnostic CT scan of the colon with
and without contrast. Here you see
how it is found in our code book. I
believe it can also be found under CT
scan so there's different ways the Index
can be used. This is just giving you one
path. Here is this particular code
showing you how it would be coded.
The reason why I have written here on
the right hand side "with and without
contrast" is because the way it's worded
in the code description it says with
contrast including non-contrast images
so instead of saying "with" and "without"
it says it this way. So I've made a note
for myself that this code means with and
without contrast. Our next example is 5.1
#4- a lumbarsacral myelography,
radiological supervision and
interpretation only. Sometimes in this
chapter the codes are for just the
radiological supervision and interpretation.
So you really have to read those. There
you go. I have a screenshot with this
code and these descriptors. As a reminder,
up at the top, the heading of these
slides, the green is a subsection (Diagnostic Radiology) in the
chapter; the spine pelvis is the part of
the body that we're looking at. Next
example (Ex. 5.1, #6), the CT scan of a lumbar spine
without contrast. There is your code.
Here is a screenshot of your code book,
showing you the code family and the
different descriptors. This is one that
does show you "without contrast", "with
contrast" and then "without followed by
with contrast".
Ex. 5.1 #8, an upper GI x-ray exam with a KUB and
here I have the code . You notice that
when we go to "X-ray, GI tract" it does
take us, refers us to "GI tract, imaging"
and then I have there all those
codes that you have to look at to choose
the correct one. Here's your code family and
you notice I have underlined "without KUB"
and "with KUB". Ex. 5.2 #2-a limited ultrasound of a
pregnant uterus to determine a fetal
position. In this case, the diagnostic
ultrasound is defined as "limited" and
you are doing it for a specific purpose,
being to determine fetal position . A lot
of times when you are selecting a code,
you are going to read the different code
descriptions within a range of codes
that's referred to you by the Index to
find a specific thing that you're
looking for. You see we have all these
ranges given to us in the Index but when
we go to these codes and start reading,
it does say fetal position will be one reason
why you would do this ultrasound.
Ex. 52 #4-an ultrasound of the kidney, complete.
You have a range of codes to read
through and when you read through, you
notice that it is defined as "complete". I have
highlighted the terms "complete" and
"limited". Look at the top of the slide.
Diagnostic ultrasound is a subsection
within this chapter and abdomen and
retroperitoneum is the part of the body
because the kidneys fall into the
retroperitoneum. If you have any
questions about Part 1, please post them
in the discussion board along with the path
you tried to use to try and find the code.
I will do my best to answer them. Please
begin now with Radiology Part 2.