Deck 3: Radiology

Question 1

3-1A RADIOLOGY REPORT, CHEST______________________________________
Professional Services: 71010-26 (X-Ray, Chest)
ICM-10-CM DX: Z49.01 (Preparatory care for subsequent treatment NEC, for dialysis)

Answer 1

The x-ray is a single (AP) chest x-ray to follow up on the placement of the central line (hemodialysis catheter). The chest x-ray is reported with 71010 with modifier -26 added on the CMS-1500 claim form to indicate that the radiologist provided only the professional component of the service. Dr. Monson is a clinic employee who inter-preted the results of this hospital outpatient's x-ray and prepared a written report.
The reason for the encounter is a follow-up to confirm central line placement and is reported with Z49.01.
In the Index of the ICD-10-CM, the main term "Preparatory care for subsequent treat-ment" is followed by "for dialysis."
If this patient had received dialysis in the past, Z99.2 (Status, dialysis) would be an appropriate secondary code, and the medical record for this patient would be referenced for confirmation of this assumption prior to reporting.

Question 2

3-2A RADIOLOGY REPORT, LINE PLACEMENT____________________________
Professional Services: 71010-26 (X-Ray, Chest)
ICM-10-CM DX: Z45.2 (Admission [for], adjustment, device, implanted, vascular access), I50.9 (Failure/failed, heart, congestive)

Answer 2

The report indicates the chest was x-rayed with one view, and it is reported with 71010 for the professional service. Modifier -26 is added to indicate that the radiologist provided only the professional component of the service.
The reason for the chest x-ray is to check the placement of the catheter (Z45.2).
Note that in the Index of the ICD-10-CM, the main term "Admission" is followed by "see also Encounter (for)" to cover both inpatients and outpatients.
The catheter was placed for monitoring the patient due to his congestive heart failure (I50.9).

Question 3

3-3A RADIOLOGY REPORT, ABDOMEN __________________________________
Professional Services: 74000-76-26 (X-Ray, Abdomen)
ICM-10-CM DX: Z46.82 (Fitting [and adjustment] [of], catheter, non-vascular), R10.9 (Pain[s], abdominal)

Answer 3

The service was an abdominal x-ray, correctly reported with 74000. The professional services would be reported with modifier -76 to indicate that this was a repeated abdominal x-ray performed on the same day by the same physician. Modifier -26 is used on the CMS-1500 to denote the professional services provided by Dr. Monson.
The encounter was for checking the placement of a nasogastric feeding tube, which is a catheter (non-vascular), and is reported with Z46.82.
In the Index of the ICD-10-CM, the main term "Fitting" is followed by "and adjust-ment of" in parentheses and subterm "catheter."
In the hospital setting, the coding would be based on the entire observation record, of which the x-ray was only one portion of the care rendered. The reason for this encounter is abdominal pain, and when coding this report, it was assumed that that was the diagnosis at discharge. There would also be many other charges besides the x-ray on this patient's bill or insurance claim.

Question 4

3-4A RADIOLOGY REPORT, CHEST______________________________________
Professional Services: 71020-26 (X-Ray, Chest)
ICD-10-CM DX: C34.01 (Neoplasm, lung, hilus, Malignant Primary)

Question 5

3-5A RADIOLOGY REPORT, FEMUR ____________________________________
Professional Services: 73552-26-LT (X-Ray, Femur)
ICD-10-CM DX: M79.652 (Pain[s], limb, lower, thigh)

Question 6

3-6A RADIOLOGY REPORT, KNEE ______________________________________
Professional Services: 73560-LT (X-Ray, Knee)

Question 7

3-7A RADIOLOGY REPORT, SHOULDER ________________________________
Professional Services: 73030-26-RT (X-Ray, Shoulder), 73030-76-26-RT (X-Ray, Shoulder)
ICD-10-CM DX: M19.011 (Osteoarthritis, shoulder)

Question 8

3-8A KUB ____________________________________________________________
Professional Services: 74000-26 (X-Ray, Abdomen)
ICD-10-CM DX: Z46.82 (Fitting [and adjustment] [of], catheter, non-vascular)

Question 9

3-9A VIDEO SWALLOW ________________________________________________
Professional Services: 74230-26 (Swallowing, Imaging)
ICD-10-CM DX: R13.10 (Dysphagia)

Question 10

3-10A CT SCAN, BRAIN ________________________________________________
Professional Services: 70450-26 (CT Scan, without Contrast, Brain)
ICD-10-CM DX: R41.82 (Alteration [of] altered, mental status)

Question 11

3-11A CT SCAN, SINUSES ______________________________________________
Professional Services: 70486-26 (CT Scan, without Contrast, Face), 76377-26 (CT Scan, 3D Rendering)
ICD-10-CM DX: I50.9 (Failure/failed, heart, congestive), R09.02 (Hypoxemia), Z99.11 (Dependence, on, ventilator)

Question 12

3-12A CT SCAN, SINUSES ______________________________________________
Professional Services: 70487-26 (CT Scan, with Contrast, face)
ICD-10-CM DX: R50.9 (Fever [of unknown origin]), Z99.11 (Dependence, on, ventilator)

Question 13

3-13A CT SCAN, CHEST ________________________________________________
Professional Services: 71250-26 (CT Scan, without Contrast, Thorax)
ICD-10-CM DX: E85.4 and J99 (Amyloidosis, with lung involvement)

Question 14

3-14A CT SCAN, ABDOMEN AND PELVIS ________________________________
Professional Services: 74176-26 (CT Scan, without Contrast, Abdomen and Pelvis)
ICD-10-CM DX: E85.9 (Amyloidosis)

Question 15

3-15A CT SCAN, CHEST________________________________________________
Professional Services: 71260-26 (CT Scan, with Contrast, Thorax)
ICD-10-CM DX: J90 (Effusion, pleura/pleurisy/pleuritic/pleuropericardial), Z90.12 (Absence, breast(s) [acquired])

Question 16

3-16A CT SCAN, CHEST, ABDOMEN, AND PELVIS ________________________
Professional Services: 71260-26 (CT Scan, with Contrast, Thorax), 74177-26 (CT Scan, with Contrast, Abdomen)
ICD-10-CM DX: R22.2 (Mass, chest), I71.4 (Aneurysm, abdominal [aorta]), R18.8 (Ascites [abdominal]), J90 (Effusion, pleural), R53.83 (Fatigue), J43.9 (Bulla[e], lung [emphysematous])

Question 17

3-17A CT SCAN, ABDOMEN ____________________________________________
Professional Services: 74160-26 (CT Scan, with Contrast, Abdomen); 76376-26 (CT Scan, 3D Rendering)
ICD-10-CM DX: R93.5 (Abnormal/abnormality/abnormalities, diagnostic imaging, abdomen/abdominal region NEC)

Question 18

3-18A CT SCAN, ABDOMEN AND PELVIS ________________________________
Professional Services: 74177-26 (CT Scan, with Contrast, Abdomen and pelvis)
ICD-10-CM DX: R94.5 (Abnormal/abnormality/abnormalities, function studies, liver)

Question 19

3-19A CT-GUIDED KIDNEY BIOPSY ____________________________________
Professional Services: 50200-50 (Biopsy, Kidney), 50200-76-RT (Biopsy, Kidney), 77012-26 (CT Scan, Guidance, Needle Placement), 76380-26 (CT Scan, Follow-Up Study)
ICD-10-CM DX: N18.9 (Insufficiency, kidney, chronic), N04.9 (Syndrome, nephrotic), D64.9 (Anemia)

Question 20

3-20A CT SCAN, BRAIN ________________________________________________
Professional Services: 70450-26 (CT Scan, without Contrast, Brain)
ICD-10-CM DX: I61.1 (Hemorrhage/hemorrhagic, intracranial, intracerebral, hemi-sphere, cortical), C71.3 (Neoplasm, brain, parietal lobe, Malignant Primary)

Question 21

3-21A ULTRASOUND, RIGHT LOWER QUADRANT ________________________
Professional Services: 76705-26 (Ultrasound, Abdomen)
ICD-10-CM DX: R10.31 (Pain[s], abdominal, lower, right quadrant), R50.9 (Fever, [with chills])

Question 22

3-22A ULTRASOUND, GALLBLADDER __________________________________
Professional Services: 76705-26 (Ultrasound, Abdomen)
ICD-10-CM DX: R10.9 (Pain[s], abdominal)

Question 23

3-23A ULTRASOUND, RENAL __________________________________________
Professional Services: 76770-26 (Ultrasound, Kidney)
ICD-10-CM DX: N04.9 (Syndrome, nephrotic)

Question 24

3-24A ULTRASOUND, GALLBLADDER __________________________________
Professional Services: 76705-26 (Ultrasound, Abdomen)
ICD-10-CM DX: R10.11 (Pain[s], abdominal, upper, right quadrant), Z99.11 (Dependence, on, ventilator)

Question 25

3-25A ULTRASOUND, RENAL __________________________________________
Professional Services: 76775-26 (Ultrasound, Kidney); 51798 (Urodynamic Tests, Bladder Capacity, Ultrasound)
ICD-10-CM DX: N18.9 (Failure/failed, renal, chronic), K81.1 (Cholecystitis, chronic), N28.1 (Cyst, kidney [acquired]), R18.8 (Ascites [abdominal])

Question 26

3-26A ULTRASOUND, RENAL __________________________________________
Professional Services: 76775-26 (Ultrasound, Kidney)
ICD-10-CM DX: R94.4 (Abnormal/abnormality/abnormalities, function studies, kidney), R34 (Oliguria)

Question 27

3-27A ULTRASOUND, RETROPERITONEAL ______________________________
Professional Services: 76775-26 (Ultrasound, Retroperitoneal)
ICD-10-CM DX: N10 (Pyelonephritis, acute)

Question 28

3-28A ULTRASOUND, RIGHT LOWER HEMITHORAX-MARKING __________
Professional Services: 76942-26 (Ultrasound, Guidance, Thoracentesis)
ICD-10-CM DX: J90 (Effusion, pleura/pleurisy/pleuritic/pleuropericardial)

Question 29

3-29A RADIATION ONCOLOGY CONSULTATION NOTE ____________________
Professional Services: 99244 (Evaluation and Management, Consultation)
ICD-10-CM DX: C79.2 (Neoplasm, skin, flank, Malignant Secondary), C61 (Neoplasm, prostate [gland], Malignant Primary), Z99.3 (Dependence, on, wheelchair)

Question 30

3-29B RADIATION ONCOLOGY TREATMENT PLANNING NOTE ____________
Professional Services: 77263 (Radiation Therapy, Planning)
ICM-10-CM DX: C79.2 (Neoplasm, skin, flank, Malignant Secondary), C61 (Neoplasm, prostrate [gland], Malignant Primary)

Question 31

3-29C RADIATION ONCOLOGY SIMULATION NOTE ______________________
Professional Services: 77290-26 (Radiation Therapy, Field Setup), 77334-26 (Radiation Therapy, Treatment Device)
ICD-10-CM DX: C79.2 (Neoplasm, skin, flank, Malignant Secondary), C61 (Neoplasm, prostrate [gland], Malignant Primary)

Question 32

3-29D RADIATION ONCOLOGY PROGRESS NOTE-WEEK 1, 5 DAYS ________
Professional Services: 77427 (Radiation Therapy, Treatment Management, Weekly)
ICD-10-CM DX: C79.2 (Neoplasm, skin, flank, Malignant Secondary), C61 (Neoplasm, prostrate [gland], Malignant Primary)

Question 33

3-29E RADIATION ONCOLOGY PROGRESS NOTE-WEEK 2, 5 DAYS ________
Professional Services: 77427 (Radiation Therapy, Treatment Delivery, Weekly)
ICD-10-CM DX: C79.2 (Neoplasm, skin, flank, Malignant Secondary), C61 (Neoplasm, prostrate [gland], Malignant Primary)

Question 34

3-30A DIAGNOSTIC PULMONARY FUNCTION STUDY ____________________
Professional Services: 78582-26 (Lung, Nuclear Medicine, Imaging, Ventilation)
ICD-10-CM DX: R09.02 (Hypoxemia)

Question 35

3-31A VENTILATION-PERFUSION LUNG SCAN __________________________
Professional Services: 78582-26 (Lung, Nuclear Medicine, Imaging, Ventilation)
ICD-10-CM DX: R07.9 (Pain[s], chest)

Question 36

3-32A RADIOLOGY REPORT, HEMODIALYSIS CATHETER PLACEMENT ______
Professional Services: 36558 (Central Venous Catheter Placement, Tunneled without Port or Pump), 76937-26 (Ultrasound, Guidance, Vascular Access)
ICD-10-CM DX: N18.9 (Failure/failed, renal, chronic)

Question 37

3-33A GASTROJEJUNOSTOMY CATHETER PLACEMENT __________________
Professional Services: 49440 (Gastrostomy Tube, Obstructive Material Removal, Placement, Percutaneous), 49446-51 (Gastrostomy Tube, Conversion, to Gastro-jejunostomy Tube)
ICD-10-CM DX: E46 (Nutrition deficient or insufficient)

Question 38

3-34A GASTROJEJUNOSTOMY CATHETER PLACEMENT __________________
Professional Services: 49440-53 (Gastrostomy Tube, Obstructive Material Removal, Placement, Percutaneous)
ICD-10-CM DX: R10.9 (Pain[s], abdominal), E46 (Malnutrition), K63.89 (Distension, distention, intestine) Z53.09 (Procedure, not done, because of, contraindication)

Question 39

3-35A GASTROJEJUNOSTOMY CATHETER PLACEMENT __________________
Professional Services: 49440 (Gastrostomy Tube, Obstructive Material Removal, Placement, Percutaneous), 49446-51 (Gastrostomy Tube, Conversion, to Gastro-jejunostomy Tube)
ICD-10-CM DX: I63.9 (Stroke), J80 (Syndrome, respiratory, distress, acute, adult), Z99.11 (Dependence, on, ventilator)

Question 40

AUDIT REPORT 3.1 INTERVENTIONAL RADIOLOGY SERVICES
Incorrect code: 77001-26

Question 41

AUDIT REPORT 3.2 EMERGENCY BRAIN CT SCAN
Incorrect code: 70470-26

Question 42

AUDIT REPORT 3.3 RADIOLOGY ULTRASOUND
Incorrect code: R10.84

Question 43

AUDIT REPORT 3.4 CT SCAN, ABDOMEN AND PELVIS
Incorrect code(s): 74177, modifier -26

Question 44

AUDIT REPORT 3.5 CT SCAN, CHEST, ABDOMEN, AND PELVIS
Incorrect/Missing code(s): 71270, 74178, modifier -26, J90, R06.02, S22.41XA, R91.1, V89.2XXA

Question 45

AUDIT REPORT 3.6 ULTRASOUND, ABDOMEN
Incorrect/Missing code(s): 76700, modifier -26, R11.2, K80.20

Question 46

Case 3-1
Interventional radiologists perform both the procedure and the radiologic services, so you will report both the procedure and radiology services.
LOCATION: Outpatient, Hospital
PATIENT: Mike Morgan
PRIMARY CARE PHYSICIAN: Ronald Green, MD
INTERVENTIONAL RADIOLOGIST: Edward Riddle, MD
EXAMINATION: CT-guided liver biopsy.
CLINICAL SYMPTOMS: Liver mass.
CT-GUIDED LIVER BIOPSY: Informed consent was obtained. The patient was placed supine on the CT table, and axial CT was performed to localize the low-density lesion within the dome of the liver medially. The right mid-axillary line skin was prepped and draped in the usual sterile fashion. The skin and subcutaneous tissues were infiltrated with 1% lidocaine. A 19-gauge coaxial needle was advanced into the low-density lesion, and axial CT was performed to confirm needle position prior to biopsy. Four 20-gauge core biopsy samples were obtained. Biopsy samples were obtained using a 20-gauge Monotype biopsy gun. The biopsy gun and coaxial needle were removed.
The patient did not receive conscious sedation. His pulse oximeter and vital signs were monitored throughout the exam. There were no complications. He tolerated the procedure well and left the radiology department in stable condition.
IMPRESSION: Successful and uncomplicated CT-guided biopsy of a low-density mass within the dome of the liver medially.
Pathology Report Later Indicated: Primary malignancy of the liver.
CPT Code(s): _________________
ICD-10-CM Code(s): _________________
Abstracting Questions:
1. What technique was used to accomplish the liver biopsy? _________________
2. What type of radiological guidance was used? _________________
3. Is the radiological guidance reported separately? _________________
4. Was sedation administered? _________________

Question 47

Case 3-2
LOCATION: Inpatient, Hospital
PATIENT: Benito Castro
ORDERING PHYSICIAN: Gregory Dawson, MD
ATTENDING/ADMIT PHYSICIAN: Gregory Dawson, MD
RADIOLOGIST: Morton Monson, MD
PERSONAL PHYSICIAN: Ronald Green, MD
EXAMINATION: Placement of a tunneled hemodialysis catheter.
CLINICAL SYMPTOMS: End-stage renal disease.
PLACEMENT OF TUNNELED #14.5 FRENCH HEMODIALYSIS CATHETER: The patient is a 62-year-old male with a history of renal failure. Placement of a tunneled hemodialysis catheter was requested by Dr. Green.
Prior to the start of the study, the procedure was explained to the patient, including the risks, complications, and alternatives. The patient understood and consented to the exam.
The patient was prepped and draped in the usual sterile fashion. An Ioban II (antimicrobial film) was placed on the skin. A 21-gauge micropuncture needle was advanced into the right internal jugular vein in the lower neck region using sterile technique under ultrasound guidance following administration of local anesthesia (1% lidocaine). Utilizing the Microvena kit, a 0.18 stainless steel wire was used to measure the distance from the junction of the right atrium/superior vena cava to the skin site, and the catheter was cut to size. A #5 French straight catheter was advanced into the internal jugular vein. The catheter was then placed to flush.
A small skin incision was placed in the upper chest region. Following administration of local anesthesia (1% lidocaine), a tunnel was obtained between the two skin incisions. A vascular sheath was then placed through the tunnel, and the catheter was advanced through the peel-away sheath.
The #5 French straight catheter was then removed under a Rosen wire, and a #10 French peel-away sheath was placed into the right internal jugular vein. The dilator and wire were then removed, and the end of the peel-away sheath was crimped to avoid blood loss with the patient holding his breath. The tip of the catheter was then advanced through the peel-away sheath with the tip of the junction of the right atrium/superior vena cava. The peel-away sheath was then removed and the catheter was adjusted to obtain a smooth transition. The cuff of the catheter was approximately 1 to 2 cm from the incision site. A single 2-0 Prolene suture was then placed at the catheter insertion site, and three sutures were placed at the lower neck incision site. There was no evidence of bleeding.
Contrast was infused through the single port, which revealed adequate placement.
Post placement chest x-ray did not reveal a pneumothorax.
The patient tolerated the procedure well. The patient denied pain and shortness of breath at termination of the study.
IMPRESSION: Placement of a tunneled #14.5 French hemodialysis catheter through the right internal jugular vein as described above.
CPT Code(s): _________________
ICD-10-CM Code(s): _________________
Abstracting Questions:
1. Was the catheter inserted by the radiologist? _________________
2. Was the catheter inserted into the venous or arterial system? _________________
3. Was the catheter inserted centrally or peripherally? _________________
4. Was the catheter tunneled? _________________
5. Was a subcutaneous port/pump inserted? _________________
6. Does the age of the patient affect CPT code assignment? _________________
7. Is ultrasound guidance separately reported? _________________