Some radiology codes include two components. Often a radiologist will use the radiology equipment, which is known as the technical component, and the physician will provide the second half of the CPT code by supervising and interpreting the study. When this occurs what should the physician report?
- The full CPT code
- The CPT code with a modifier TC
- The CPT with a modifier 26
- The CPT with a modifier 52
A patient presents to the ER with intractable nausea and vomiting, and abdominal pain that radiates into her pelvis. The physician orders a CT scan of the abdomen, first without contrast and then followed by contrast, and a CT of the pelvis, without contrast.
- 74176, 74178-51
- 74178 x2, 74177
- 74178, 74176-51
A patient was in an MVA and his face struck the steering wheel. He had multiple contusions and facial swelling. The physician suspected a zygomatic-malar or maxilla fracture. The radiologist took an oblique anterior-posterior projection which showed the facial complex clearly. An anterior-posterior and lateral views were also taken.
If a prior study is available but it is documented in the medical records that there was inadequate visualization of the anatomy, then a diagnostic angiography may be reported in conjunction with an interventional procedure if modifier 59 is appended to the diagnostic S&I.
A physician performed a deep bone biopsy of the femur. The trocar was visualized and guided using a CAT scan and interpretation was provided.
- 20225, 73700
- 38221, 76998
- 20225, 77012
- 20245, 77012-26
HDR internal radiation therapy was performed by using a remote controlled MultiSource afterloader which was connected to 3 catheters. The 6 Ir-192 radioactive wire sources were released from the containment unit and were delivered beside the tumor within the body cavity, as pre-determined. After 15 minutes the sources were removed from the patient and placed back into the containment unit.
A patient has a myocardial perfusion imaging study which included quantitative wall motion, ejection fraction by gated technique, and attenuation correction. The study was done during a cardiac stress test which was induced by using dipyridamole. The physician supervised, the interpretation and report were completed by the cardiologist.
- 78453, 93016
- 78451, 93016
A 35 year old mother carrying twin gestations, who has a three year old child with down syndrome, comes in for a prenatal screening. She is in her 12th week of pregnancy and the physician requests that the amount of fluid behind the necks of the fetuses be measured. A transabdominal approach was used.
- 76801, 76802
- 76811, 76812
- 76813, 76814
- 76816, 76816-59
A dialysis patient presents in the radiology department. His physician suspects that the tip of his Hickman’s catheter in his left forearm may have migrated from its original placement. The vascular surgeon on-call injects radiopaque iodine into the patient’s port and examines it under fluoroscopic imaging.
- 36598, 75820, 76000
- 36598, 75820
A written report signed by the interpreting physician should be considered an integral part of the radiological procedure or interpretation.
Pathology and Laboratory
A physician orders a patient’s blood be tested for levels of urea nitrogen, sodium, potassium, transferase alanine and aspartate amnio, total protein, ionized calcium, carbon dioxide, chloride, creatinine, glucose, and TSH.
- 80053-52, 84443
- 80048, 84443, 84155, 84460, 84450
- 80047, 84460, 84450, 84155, 84443
- 80051, 84520, 84460, 84450, 84155, 82330, 82565, 82947, 84443
A specimen labeled “right ovarian cyst” is received for examination. It consists of a smooth-walled, clear fluid filled cyst measuring 13x12x7 cm and weighing 1351 grams with fluid. Both surfaces of the wall are pink-tan, smooth and grossly unremarkable. No firm or thick areas or papillary structures are noted on the cyst wall externally or internally. After removal the fluid, the cyst weight 68 grams. The fluid is transparent and slightly mucoid.
A patient presents to the ED with chest pain, shortness of breath, and a history of congestive heart failure. The physician performs a 12 lead EKG which indicates a myocardial infarction without ST elevations. The physician immediately orders myoglobin, quantitative troponin, and CK enzyme levels to be run once every hour for three consecutive hours.
- 83874 x3, 84484 x3, 82550 x3
- 83874-91 x3, 84484-91 x3, 82250-91 x3
- 83874, 83874-91 x2, 84484, 84484-91 x2, 82550, 82550-91 x2
- 82250-76, 82250-91
- 83874-99, 83874-76, 83874-91, 84484-99, 84484-76, 84484-91, 82250-99,
A 17 year old female presents in her family physician’s office complaining of nausea, vomiting, and weight gain. She has been experiencing these symptoms on and off for two weeks. An analysis of the urine reveals a positive pregnancy test and hCG levels of 12500 mIU/ml confirm she is in her sixth week of pregnancy.
- 81005, 84703
- 81025, 84703
- 81025, 84702
- 81005, 84702
An employee was randomly selected for a drug screen. According to the employer it is standard procedure to use a multiplex screening kit and test for barbiturates, cocaine, opiates, and methadone. Any drug with a positive result should be confirmed with a second, quantitative test. The employee showed positive for barbiturates and opiates. Secondary tests were run on the two and levels came back with 350 ng/ml for barbituates and 375 ng/ml for opiates.
- 80101, 80101-91 x3, 80102, 80102-91
- 80104, 80104-91 x3, 80102, 80102-91
- 80100, 80100-91 x3, 82205, 83925
- 80104,82205, 83925
A CBC does not include which of the following:
A couple that was unsuccessful at conceiving a child chooses to have in vitro fertilization done. The eggs and semen have been harvested and nine eggs were implanted with a sperm. The zygotes went through mitosis and produced embryos. Three embryos were then implanted in the woman and the other six were kept for later use. What codes(s) would the lab technician charge for her services in preserving the remaining six embryos?
- 89255 x6
A patient in her 30th week of pregnancy has a high oral glucose reading and her physician orders a glucose tolerance test. Upon arrival the laboratory technician draws the patient’s blood and the patient then ingests a glucose drink. Her blood is then drawn one, two, and three hours after the ingestion. As the patient was leaving the laboratory the technician informs her that the samples were incorrectly labeled and that the test needed to be repeated. The patient has her blood drawn again, ingested the glucose drink again, and has her blood re-drawn at one, two, and three hour intervals.
- 82951, 82951-91
- 82946, 82946-91
- 82947, 82950, 82950-91 x2
Carbon dioxide, total calcium, and sodium and all in what three panels?
- 80047, 80069, 80051
- 80048, 80053, 80069
- 80069, 80047, 80048
- 82374, 82310, 84295
A qualitative hCG test will provide a positive or negative result while a quantitative hCH test will provide a specific amount of hCG in the specimen.
A 5year old is brought into the ER after being attacked by a stray dog. The stray was captured and tested positive for rabies. The patient has a 3cm laceration on his right cheek that requires simple closure and a 1cm and 4cm laceration on his upper left arm requiring layered repair. After discussing the benefits and risks with the patient’s parents they decide to have an IM rabies vaccination administered by the physician, due to the patient’s rabies exposure.
- 873.41, 880.09, V01.5, 12032, 12013-51, 90460-51, 90375
- 873.41, 880.09, V04.5, 12032, 12013-51, 90471-51, 90675-51
- 873.41, 880.09, V01.5, 12032, 12013-51, 90460-51, 90675
- 873.41, 880.03, V04.5, 12013, 12031-51, 12032-51, 96372-51, 90375
A 52 year old male is in the emergency department complaining of dizziness and states he passed out prior to arrival. The physician evaluates him, orders that a 12 lead EKG be performed, and has the nurse infuse 2 liters of NS over a 1 hour and 45 minute time period under his supervision. The EKG results were reviewed by the physician and were normal. A report was written and the patient was diagnosed with syncope due to dehydration and released. In addition to the EM service what should the physician code for?
- 93000, 96360, 96361
- 93000, 96360
- 93010, 96360, 96361
A 45year old patient with end stage renal disease has in home dialysis services initiated on the 15th of the month. The physician provides dialysis every day. On the 19th the patient was admitted to the hospital and discharged on the 24th. The physician and patient began in-home dialysis again on the 25th and continued every day until the 31st.
- 90970 x11
A patient with a dual lead implantable cardioverter-defibrillator has his physician initiate remote monitoring of the ICD and of cardiovascular monitor functionality (within the ICD), to help diagnosis the patient with what he suspects is left sided heart failure. Over the course of 90 days the physician remotely analyzes recorded data from the device, including left atrial pressure, ventricular pressure, and the patient’s blood pressure. He also remotely analyzes data from the defibrillator, including the heart rhythms and pace. After analysis and review the physician compiles reports on both. During this time period there was also one in-person interrogation of the ICM device and one in-person encounter for programming and adjusting the ICD device to ensure test functions and to optimize programming.
- 93297 x3, 93295, 93283
- 93297, 93295, 93283
- 93297, 93295, 93290, 93283
- 93297 x3, 93295, 93290, 93283
History: Past ocular surgery history is significant for neurovascular age-related dry macular degeneration. Patient has had laser four times to the macula on the right and two times to the left. Exam: Established 63 year old female patient. On examination, lids, surrounding tissues, and palpebral fissure are all unremarkable. Conjunctiva, sclera, cornea and iris were all assessed as well. Palpitation of the orbital rim revealed nothing. Visual acuity with correction measured 20/400 OU. Manifest refraction did not improve this. There was no afferent pupillary defect. Visual fields were grossly full to hand motions. Intraocular pressure measured 17 mm in each eye. Vertical prism bars were used to measure ocular deviation and a full sensorimotor examination to evaluate the function of the ocular motor system was performed. A slit-lamp examination was significant for clear corneas There was early nuclear sclerosis in both eyes. There was a sheet like 1-2+ posterior subcapsular cataract on the left. Dilated examination by way of cycloplegia showed choroidal neovascularization with subretinal heme and blood in both eyes. Magnified inspection was obtained with a Goldman 3-mirror lens and the retina, optic disc, and retinal vasculature were visualized. Macular degeneration was present in both the left and right retinas.
Assessment/Plan: Advanced neurovascular age-related macular degeneration OU, this is ultimately visually limiting. Cataracts are present in both eyes. I doubt cataract removal will help increase visual acuity; however, I did discuss with the patient, especially in the left, that cataract surgery will help us better visualize the macula for future laser treatment so that her current vision can be maintained. We discussed her current regiments and decided to continue with the high doses of the vitamins A, C and E, and the minerals zinc and copper to help slow her degeneration. After consideration the patient agreed to left cataract surgery which we scheduled for two weeks from today.
- 92012, 92060, 92081
- 92014, 92060
Some procedures or services are commonly carried out as an integral component of another total service or procedure and are identified by the inclusion term “separate procedure”. Codes with this inclusion term should not be reported in addition to the total procedure code or service to which it is considered an integral part, unless it is independently carried out or considered unrelated. If performed independently or as an un-related procedure it may be coded with modifier 59 appended to it.
A 73 year old group home resident with end stage renal disease has a nurse come in on Mondays, Wednesdays, and Fridays to perform peritoneal dialysis. Each dialysis session lasts three hours. Once a week, (on Friday), the nurse also assists the patient with his meals, cleaning, and grocery shopping. What should the nurse charge for a month (30 days) of services if the 1st of the month landed on a Monday?
- 99512 x 13, 99509 x4
- 90966, 99509 x4
- 99601 x13, 99602 x13, 99509 x4
- 99601, 99602 x25, 99509 x4
The physician performs a non-imaging physiological recording of pressure on the left leg with Doppler analysis of blood flow in both directions. ABIs were taken at the back and front lower aspect of the tibial and tibial/dorsalis pedis arteries. In addition 2 levels of plethymography volume and oxygen tension were taken.
Due to a suspected gastric outlet obstruction a manometric study is performed. Using nuclear medicine the physician monitors the time it takes for food to move through the patient’s stomach, the time it take the patient’s stomach to empty into the small intestine, and how fully it empties.
Which of the following drugs is not pending FDA approval