MEDICAL BILLING AND CODING
Radiology – 70000 Section
CHAPTER 23
Radiology – uses radiant energy to diagnose and treat patients. (pg 661 SBS TB)
Radiologist - The physician that specializes in radiology (pg 661 SBS TB)
70000 Section of CPT – pg 661 SBS TB, pg 343 – 383 CPC Bk
Divided into 7 sections
Diagnostic Radiology (Diagnostic Imaging)
Diagnostic Ultrasound
Radiologic Guidance
Breast, Mammography
Bone/Joint Studies – see note further in chapter outline
DEXA Scan
Nuclear Medicine
MRA
Suffix (-graphy) – “making of a film” using a variety of methods
Body Planes – on pg 666 of SBS TB and xix of the CPT book
Planes of the Body
Coronal Plane, divides the body into front and rear sections. Also called the frontal
plane. Frontal plane, divides the body into front and rear sections. Also called the
coronal plane. (ex. Divides the front of the body from the back of the body)
Horizontal Plane, divides the body into a superior (or upper) and an inferior (or lower)
section. Also called the transverse plane. Transverse Plane, divides the body into a
superior (or upper) and an inferior (or lower) section. Also called the horizontal plane.
(Think how a plane flies. A plane flies horizontally across the sky) Transverse – plane
flies across or thru, a plane goes up and down)
Median Plane, divides the body into right and left halves. Also called the midsagittal
plane. Midsagittal Plane, divides the body into right and left halves. Also called the
median plane.
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Direction and Location

Anterior, front side of the body, also known as ventral.

Caudal, in quadrapeds, the tail end [see inferior].

Cranial, above or near the head, also known as superior.

Distal, farthest end from the trunk or head.

Dorsal, back side of the body, also known as the posterior.

Inferior, below also, toward the feet.

Infra-, prefix meaning below or under.

Lateral, away from the midline.

Medial, toward the midline.

Posterior, back side of the body, also known as the dorsal.

Proximal, closest part nearest the trunk or head.

Superior, above or near the head, also known as cranial.

Supra-, prefix meaning above or over.

Ventral, front side of the body, also known as anterior.
Anatomical Directional Terms:
Anterior: In front of, front
Posterior: After, behind, following, toward the rear
Distal: Away from, farther from the origin
Proximal: Near, closer to the origin
Dorsal: Near the upper surface, toward the back
Ventral: Toward the bottom, toward the belly
Superior: Above, over
Inferior: Below, under
Lateral: Toward the side, away from the mid-line
Medial: Toward the mid-line, middle, away from the side
Rostral: Toward the front
Caudal: Toward the back, toward the tail
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Anatomical Body Planes:
Lateral Plane or Sagittal Plane: Imagine a vertical plane that runs through your body
from front to back or back to front. This plane divides the body into right and left regions.
Median or Midsagittal Plane: Sagittal plane that divides the body into equal right and
left regions.
Parasagittal Plane: Sagittal plane that divides the body into unequal right and left
regions.
Frontal Plane or Coronal Plane: Imagine a vertical plane that runs through the center
of your body from side to side. This plane divides the body into front (anterior) and back
(posterior) regions.
Transverse Plane: Imagine a horizontal plane that runs through the midsection of your
body. This plane divides the body into upper (superior) and lower (inferior) regions.
Radiographic Procedures
 Fluoroscopy – visualizes of internal organs in motion.
 MRI - Magnetic Resonance Imaging – uses magnetism, radio waves, and a
comuter to produce images of body structures
 Tomography – produces a two-dimensional image of a slice or section, through a
3-dimensional object.
 Biometry – uses an application of a statistical method to a biologic fact
Planes of the Body
 Position – how a patient is placed during the exam
 Projection – path of the x-ray beam
Different Positions – pictures on pg 666 of SBS TB
 Prone – patient is lying on his or her front
 Proximal – Close to the trunk of the body
 Distal – Farthest from that body part
 AP – Anteroposterior – patient has his or her front closed to the machine
 PA – Posteroanterior – patient has his or her back closed to the machine
 Lateral Position – side positions
o Right lateral – patient’s right side is closed to the film
o Left lateral – patient’s left side is closed to the film
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 Dorsal – back (think of the dorsal fin of a dolphin or shark0
o Supine – lying on the back
o Ventral (anterior) – lying on the stomach
o Lateral (side) – lying to the side
 Decubitus – “lying positions”
o Ventral – lying on the stomach
o Supine – lying on the back
 Recumbent – lying down
o Right lateral – lying on the right side
o Left lateral – lying on the left side
 Oblique – body is rotated (think of your obliques which are the sides of your
stomach)
o Left anterior – left side rotated toward the table
o Right anterior – right side rotated toward the table
o Left posterior
o Right posterior
Pages 668 – 669 SBS TB
 Guidelines located on pgs 346-347 of CPT Bk
o Modifier -26 - Professional – reading of the film
o Modifier -TC - Technical - equipment
o Global – professional and technical components are both included in the
CPT code
MUE’s – Medically Unlikely Edits, pg 671 SBS TB – services that just can’t happen
e.g. – hysterectomy on a male
What to watch for: verbage using the following
Radiographic Contrast – pg 672 SBS TB
 Contrast material
 With Contrast
 Without Contrast
 With and Without Contrast
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***Note: Same examples used in Chapter 16 handout.
Diagnostic Radiology Subsection (70010 – 76499), pg 672-678 SBS TB
 Contains plain X-Ray film
 CPT Index – can look under Scan and will direct you to the correct place
o CT - 72192
o MRI - 72195
o MRA – 72198
o PET – CPT depends on where performed
o Angiography CAT Scan – uses dyes injected into the blood vessels
Ex. CT of abdomen and pelvis: Technique: CT of the abdomen and pelvis was
performed without oral or IV contrast material per physician request. No previous CT
scans for comparison.
Findings: No ascites. Moderate-sized pleural effusion on the right.
A.
B.
C.
D.
74160-26, 789.59
74150-26, 511.9
74150, 511.9
74160, 789.59
Ex. This 69-year-old female is in for a magnetic resonance examination of the brain
because of new seizure activity. After imagining without contrast, contrast was
administered, and further sequences were performed. Examination results indicated
no apparent neoplasm or vascular malformation.
A.
B.
C.
D.
70543-26 (reading of the scan), 780.31
70543-26, 780.39
70553-26, 780.39 (other convulsions) – seizure NOS
70553 (professional and technical components of the scan), 345.90 (seizure
disorder NOS without mention of intractable epilepsy)
70543 – Magnetic resonance (eg. Proton) imaging, orbit, face, and/or neck without
contrast material(s) followed by contrast material(s) and further sequences
70553 – Magnetic resonance (eg. Proton) imaging, brain (including brain stem) without
contrast material, followed by contrast material(s) and further sequences.
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Movies
Getting a CAT Scan (Video)
Getting an MRI (Video)
http://kidshealth.org/kid/closet/movies/how_the_body_works_interim.html
http://kidshealth.org/kid/htbw/CSmovie.html
Mammography (77051 – 77059) - pg 674 SBS TB
 Description for mammography is bilateral since scans are performed on both
breasts
 If fewer than the total number of views are taken, use modifer – 52
o Regular Mammogram screening code – 77057 (pg 372 CPT)
Diagnostic Ultrasound (76509 – 76999) – pg 675-676 SBS TB)
 Uses high frequency sound waves to get an image
 Can be found under Ultrasound in the Indewx and then by anatomical site or
procedure
 Transducer – the device placed directly on to the skin to which a gel has been
applied
 Codes are located in three areas:
o Radiology (76509 - 76999)
o Medicine section, Non-Invasive Vascular Diagnostic Studies (93875 –
93990)
o Medicine section, Echocardiography (93303 – 93350)
Interventional Radiologist – physician who is skilled in both the surgical procedure and
the radiology portion of an interventional radiologic service.
Board Certified Physician and can provide minimally invasive treatments.
Modes and Scans pg 677-678 SBS TB
 A-mode – one dimensional display reflecting time
 M-mode – one dimensional display of the movement of structure
 B-scan – two-dimensional display of the movement of tissues and organs
 Real-time scan – two-dimensional display of both the structure and the motion of
tissues and organs….
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Radiology – 70000 Section
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Ultrasonic Guidance Procedures – 76930 – 76999
 Example: Doppler ultrasound – use of sound that can be transmitted only
through solids or liquids. Used to measure moving objects and is ideal for
measuring bloodflow.
 Word association (the weather man is always talking about Doppler Radar when
tracking storms)
Bone/Joint Studies (77071-77084), pg 372 CPT, not in the SBS TB
 Can be found in the index under Bone Density Study. Cannot find by looking
under DEXA
 Watch for the type of scan
o If looking under Bone in the index, you will find a density study under CT
Scan, S-Ray. Will also find “Scan – See Bone, Nuclear Medicine, Nuclear
Medicine Imaging”
Radiation Oncology Subsection –(77261 – 77799), pg 379 SBS TB
 Used when utilizing radiation to destroy tumors instead of chemotherapy
 Guidelines on pg 373 CPT
o Note: The initial consultation is coded using and E/M code.
 Clinical Treatment Planning
o Simple
o Intermediate
o Complex
Simulation (77280 – 77299)
 Used to determine treatment areas and the placement of the ports for radiation
treatment, but does not include the administration of the radiation
 Find in the index under the main term “Radiology Therapy”.
o Simple
o Intermediate
o Complex
o Three-dimensional (3D)
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Medical Radiation Physics, Dosimetry, Treatment Devices, and Special Services
(77300 – 77370, 77399), pg 680 SBS TB
Dosimetry – calculation of the radiation dose and placement.
Located in the index under “Radiation Therapy”
Simple
Intermediate
Complex
Stereotactic Radiation Treatment Delivery (77371-77373), pg 681 SBS TB
And Radiation Treatment Delivery (77401-77423)
 *Reflects the technical components only
 Reports the actual delivery of the radiation
o Areas treated (1, 2, 3, or more)
o Ports involved (1, 3 or more, tangential)
o Blocks used (none, multiple, custom)
Radiation Treatment Management (77427 – 77499)
 #Reports the professional component of treatment
o Services covered under this are bundled up to 90 days after the end of
radiation treatment.
o Read the guidelines on page 376 CPT
Ex. Report both the technical and professional components of the following service:
This 68-year-old male is seen in Radiation Oncology Department for prostate cancer.
The oncologist performs a complex clinical treatment planning, dosimetry calculation,
complex isodose plan; treatment devices include blocks, special shields, wedges, and
treatment management. The patient had 5 days of radiation treatments for 2 weeks, a
total of 10 days of treatment.
A.
B.
C.
D.
77263, 77300, 77315, 77334, 185
77300, 77315, 77334, 77427 x 2, 185
77263, 77300, 77315, 77334, 77427 x 2, 185
77263, 77427 x 2, 185
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77263 – Therapeutic radiology treatment planning – complex
77300 – Base radiation, dosimetry, calculation, central axis depth dose calculation,
TDF, NSWD, gap calculation, off axis faxtor, tissue inhomogeneity factors, calculation of
nonionizing radiation surface and depth dose, as required during course of treatment,
only when prescribed by the treating physician
77315 – Teletherapy, isodose plan (whether hand or computer calculated); complex
(mantle or inverted Y, tangential ports, the use of wedges, compensators, complex
blocking, rotational beam, or special beam considerations
77334 – Treatment devices, design and construction; complex (irregular blocks, special
shields, compensators, wedges, molds or casts)
77427 – Radiation treatment management, 5 sessions (aka fractions)
Proton Beam Treatment Delivery (77520 – 77525) pg 683 SBS TB, pg 376 CPT
 Simple
 Intermediate
 Complex
Hyperthermia (77600 – 77615), pg 683 SBS TB, pg 376-377 CPT
 Increase in body temperature and is used as an adjunct to radiation therapy or
chemotherapy for the treatment of cancer.
o Internal – insertion of a heat-producing probe into a body orifice
o External – application to the skin of a heat source
1. What are the different methods of hyperthermia?
Several methods of hyperthermia are currently under study, including local,
regional, and whole-body hyperthermia

In local hyperthermia, heat is applied to a small area, such as a tumor,
using various techniques that deliver energy to heat the tumor. Different
types of energy may be used to apply heat, including microwave,
radiofrequency, and ultrasound. Depending on the tumor location, there are
several approaches to local hyperthermia:
o
External approaches are used to treat tumors that are in or just
below the skin. External applicators are positioned around or near the
appropriate region, and energy is focused on the tumor to raise its
temperature.
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

o
Intraluminal or endocavitary methods may be used to treat
tumors within or near body cavities, such as the esophagus or rectum.
Probes are placed inside the cavity and inserted into the tumor to
deliver energy and heat the area directly.
o
Interstitial techniques are used to treat tumors deep within the
body, such as brain tumors. This technique allows the tumor to be
heated to higher temperatures than external techniques. Under
anesthesia, probes or needles are inserted into the tumor. Imaging
techniques, such as ultrasound, may be used to make sure the probe is
properly positioned within the tumor. The heat source is then inserted
into the probe. Radiofrequency ablation (RFA) is a type of interstitial
hyperthermia that uses radio waves to heat and kill cancer cells.
In regional hyperthermia, various approaches may be used to heat large
areas of tissue, such as a body cavity, organ, or limb.
o
Deep tissue approaches may be used to treat cancers within the
body, such as cervical or bladder cancer. External applicators are
positioned around the body cavity or organ to be treated, and
microwave or radiofrequency energy is focused on the area to raise its
temperature.
o
Regional perfusion techniques can be used to treat cancers in the
arms and legs, such as melanoma, or cancer in some organs, such as
the liver or lung. In this procedure, some of the patient’s blood is
removed, heated, and then pumped (perfused) back into the limb or
organ. Anticancer drugs are commonly given during this treatment.
o
Continuous hyperthermic peritoneal perfusion (CHPP) is a
technique used to treat cancers within the peritoneal cavity (the space
within the abdomen that contains the intestines, stomach, and liver),
including primary peritoneal mesothelioma and stomach cancer. During
surgery, heated anticancer drugs flow from a warming device through
the peritoneal cavity. The peritoneal cavity temperature reaches 106–
108°F.
Whole-body hyperthermia is used to treat metastatic cancer that has
spread throughout the body. This can be accomplished by several
techniques that raise the body temperature to 107–108°F, including the use
of thermal chambers (similar to large incubators) or hot water blankets.
http://www.cancer.gov/cancertopics/factsheet/Therapy/hyperthermia
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Clinical Brachytherapy (77750 – 77799), pg 683-684 SBS TB, 377 CPT
 Involves the precise placement of radiation sources directly at the site of the
cancerous tumor
 Guidelines on page 377 CPT
 Source – intracavitary placement or permanent interstitial (means seed implant
therapy) placements
 Ribbons – temporary interstitial placement (note: no intracavitary placement
here)
o Simple
o Intermediate
o Complex
Example: Prostate Cancer
Before the seeds are implanted, the patient receives anesthesia. Needles
containing the seeds are then inserted through the skin of the perineum (the area
between the scrotum and anus) using ultrasound guidance. The seeds remain in the
prostate, where the radioactive material gives off localized radiation for a number of
months to destroy the prostate cancer.
Website link for scenario above.
http://www.prostate-cancer-institute.org/prostate-cancer-treatment/brachytherapy.html
Website for the below information on Brachytherapy
http://nyp.org/health/radiology-brachy.html
Brachytherapy is radiation treatment that is given inside the patient, as close to the
cancer as possible. The radiation is delivered inside the body with radioactive isotopes
(chemical elements), inside delivery devices such as wires, seeds, or rods. These
devices are called implants.
Brachytherapy allows for a higher total dose of radiation over a shorter period of time
than does external beam therapy. The radiation dose is concentrated on the cancer
cells and less damage is done to the normal cells near the cancerous growth.
Brachytherapy may be performed in combination with external beam therapy to help
destroy the main mass of tumor cells for certain types of cancer.
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Brachytherapy is often used in the treatment of cervical, uterine, vaginal, prostate, or
rectal cancer, as well as eye and certain head and neck cancers. However, the therapy
may also used to treat many other cancers.
How does brachytherapy work?
There are three types of brachytherapy delivery:
 intracavitary treatment - radioactive implants are placed inside body cavities
such as the vagina or uterus.
 interstitial treatment - radioactive implants are placed directly into the tumor
and may stay in the patient permanently.
 unsealed internal radiation therapy - a medication containing radioactive
materials is injected into a vein or into a body cavity.
 Brachytherapy implant placement may be one of two types:
 permanent brachytherapy
Also called low dose rate brachytherapy, permanent brachytherapy uses
implants called pellets or seeds. These implants are very small, about the size of
a grain of rice. The implants are inserted directly into a tumor through thin, hollow
needles. The implants are left in place after the radiation has been used up, as
their small size causes little or no discomfort.
 temporary brachytherapy
Temporary brachytherapy refers to the use of implants that are removed after the
treatment has ended. Implants, such as hollow needles, catheters (hollow tubes),
or balloons filled with fluid, are inserted into or near the cancer for a period of
time, then removed. Either high-dose or low-dose brachytherapy may be used.
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General anesthesia may be used during the insertion of implants, depending on the size
and number of implants, as well as the location of the insertion site.
Generally, a person having brachytherapy will be treated on an inpatient basis, in order
to protect others from the effects of the radiation while it is active inside the person's
body. Although each facility may have specific protocols in place for the treatment of
patients undergoing brachytherapy, generally, treatment protocols may include the
following:
 placing brachytherapy patients in a private room
 limiting hospital staff time in the patient's room, but all necessary care will
be given
 placing portable shields between the patient and staff/visitors
 limitations for visitors, which may include:
 pregnant women or children under a certain age should not visit
 a limit on the length of visits
 a limit on how close to get to the patient

How long does the radiation last?
How long the radiation lasts will depend on the type of treatment given. The physician
will determine the brachytherapy type based on the type of cancer being treated, the
location of the cancer, and other considerations. If the brachytherapy implant is a lowdose implant, the implant may be left in for several days. High-dose implants may be
removed after only a few minutes.
Some implants are permanent and will be left in place. After placement of a permanent
implant, a hospital stay of a few days may be required, depending on the dose of
radiation and the location of the implant. The radiation becomes weaker each day, and
the patient will mostly likely be discharged from the hospital in a few days. There may
be certain safety measures to be taken at home. The physician will give specific
instructions if necessary.
Temporary implants will be removed after the complete dose of radiation has been
received.
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DaVinci Robot Coding
 HCPCS Code - S2900 Surgical techniques requiring use of robotic surgical
system (List separately in addition to code for primary procedure)
 Note: Many insurance companies are not paying for this as they consider use of
the Robot not medically necessary.
 Coders must bill the HCPCS code along with the surgical procedure codes for
the surgery. Why? To establish a consistent process for the reimbursement
and adjudication of claims submitted with add-on code S2900 for Robotic
Assisted Surgery.
 http://www.bing.com/images/search?q=Da+Vinci+Surgical+Robot&FORM=IGRE
&qpvt=Da+Vinci+Surgical+Robot#
o Shows lots of pictures of the Robot
 http://www.virtualworldlets.net/Shop/ProductsDisplay/VRInterface.php?ID=26
o History of the Robot , how it was named, what it’s real purpose was and
what it’s used for today
Used in procedures that treat a range of conditions. Check with your provider to see
what procedures are being used with the DaVinci Robot.
 Bladder Cancer
 Colorectal Cancer
 Coronary Artery Disease
 Endometriosis
 Gynecologic Cancer
 Kidney Cancer
 Prostate Cancer
 Throat Cancer
 Thyroid Cancer
 Uterine Fibroids
 Uterine Prolapse
Example: A provider performs a laparoscopic prostatectomy with robotic assistance.
The physician bills for the services 55866 (laparoscopy, surgical prostatectomy,
retropubic radical, including nerve sparing), with the add-on code S2900 (indicating
robotic assistance). Payment will be made only for the base procedure 55866.
See below for Cigna’s website policy
http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medi
cal/pc_modifier_Robotic_Assisted_Surgery_Reimbursement_Policy.pdf
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Nuclear Medicine – 78000 – 79999, pg 684-685 SBS, pg 378-383 CPT
 Nuclear Medicine tests are performed in three parts: tracer administration,
taking the pictures, and analyzing the images.
 Terms:
o Reversible ischemia – heart musle death has not occurred
o Irreversible – heart muscle death has already occurred
 Type of Test:
o Stress test
 Used on patients with heart problems.
http://www.cheyrad.com/medicine.html
Radiographic Tests / Procedures
X-Rays – an X-ray allows your doctor to take pictures of the inside of your body
CT Scans – Ct scans collect x-rays that have passed through the body (those not
absorbed by tissue) with an electronic detector mounted on a rotating frame rather than
on filem.
MRI’s – use magnetic waves
MRA’s – Magnetic Resonance Angiography with or without contrast – images blood
vessels
PET Scan – Position Emission Tomography – used to determine if a tumor is malignant
or benign
MUGA Scan – Multi-Gated Acquisition Scan – nuclear medicine used to evaluate the
function of the heart ventricles.
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