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CPT Code for Radiology: An In-Depth Radiology Coding and Billing

Radiology billing has become increasingly complex in recent years. With the introduction of new technologies and procedures, it is essential for medical billers to be familiar with CPT codes for radiology billing services .

• Radiology CPT Codes: A Quick Overview

• 70010-76499: Diagnostic Radiology Procedures

Covering X-rays, CT scans, and MRIs for in-depth diagnosis

70010-70559: X-rays and imaging for head and neck conditions.

71045-71555: X-rays and CT scans for chest issues.

72020-72295: X-rays and myelography for musculoskeletal assessment.

73000-73225: X-rays for upper limb diagnosis.

73501-73725: X-rays for lower limb assessments.

74018-74190: CT scans for abdominal conditions.

74210-74363: Radiological assessment of the gastrointestinal tract.

74400-74485: Renal X-rays and pyelography for urinary issues.

74710-74775: Imaging for women’s health.

75557-75574: Specialized radiological procedures for cardiac conditions.

• 76506-76999: Diagnostic Ultrasound Procedures

76506-76536: Ultrasound for head and neck assessments.

76604-76642: Ultrasound scans focused on chest conditions.

76700-76776: Abdomen: Ultrasound for abdominal and retroperitoneal evaluations.

76800-76800: Ultrasound specifically for the spinal canal.

76801-76857: Ultrasound for pelvic area assessments.

76870-76873: Dedicated ultrasound procedures for genitalia examinations.

76881-76886: Ultrasound scans for extremities and musculoskeletal conditions.

76932-76965: Ultrasound guidance for medical interventions.

76975-76999: Other ultrasound procedures for various diagnostic needs.

• 77001-77022: Radiologic Guidance

Here are the subcategories:

Fluoroscopic Guidance: 

77001-77003: Real-time X-ray guidance for interventional procedures.

Computed Tomography Guidance: 

77011-77014: CT imaging for procedural guidance.

Magnetic Resonance Imaging Guidance:

77021-77022: MRI-based guidance for medical interventions.

Incorporating Radiologic Guidance into medical procedures enhances precision and accuracy. These subcategories encompass real-time X-ray, CT imaging, and MRI-based guidance, providing invaluable support during interventional processes, and ensuring patients receive the best care possible.

• 77046-77067: Breast, Mammography

Focused on breast health assessments.

• 77071-77092: Bone/Joint Studies

Examining musculoskeletal conditions and injuries

• 77261-77799: Radiation Oncology Treatment

Within this category, an array of CPT codes is dedicated to radiation oncology treatment, encompassing diverse aspects of therapy. These codes serve as crucial tools in the comprehensive management of cancer and other medical conditions.

77261-77299: Radiation Therapy Treatment Planning (External and Internal Sources)

77295-77370: Radiation Therapy Equipment, Physics, and Dosimetry Services

77371-77387: Stereotactic Radiation Therapy Delivery

77399-77417 : Radiation Therapy Delivery

77423-77425: Neutron Beam Therapy Delivery

77427-77499: Radiation Therapy Management

77520-77525: Proton Beam Radiation Therapy Delivery

77600-77615: Radiation Hyperthermia Therapy

77620-77620: Clinical Intracavitary Radiation Hyperthermia Therapy

77750-77799: Clinical Brachytherapy Radiation Therapy

Within this comprehensive category, CPT codes are pivotal tools for radiation oncology treatment, addressing a spectrum of therapeutic aspects crucial for managing cancer and other medical conditions.

• 78012-79999: Nuclear Medicine Procedures

Nuclear medicine procedures encompass a wide range of diagnostic and therapeutic techniques that utilize radioactive materials to visualize and treat various medical conditions. These codes are essential tools in modern healthcare, enabling the precise assessment and management of a diverse array of illnesses.

78012-78999: Diagnostic Nuclear Medicine Techniques

79005-79999: Therapeutic Nuclear Medicine Interventions

These codes cover a multitude of nuclear medicine techniques, from diagnostic scans that aid in disease diagnosis and localization to therapeutic interventions that utilize radiopharmaceuticals for targeted treatment. These procedures significantly contribute to the advancement of personalized medicine and patient-centered care.

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9 Key Radiology Medical Coding Tips that Coders Should Never Forget

by Meghann Drella | Published on Apr 1, 2019 | Specialty Practices

Diagnostic imaging procedures such as x-rays, computer tomography (CT) scans, and Magnetic Resonance Imaging (MRI) have to be reported using the right codes on medical claims. Medical coding guidelines for all specialties including radiology are constantly updated and it is critical for radiology medical billing companies as well as practices to keep in pace with these updates. The correct procedure codes and modifiers are needed for insurers to accept radiology medical claims and provide the correct reimbursement.

Common radiology coding errors are those related to eligibility checks, referrals, and dictation errors. In rare cases, such as if a patient fails to complete the test, clear documentation in the report is crucial to describe the incomplete procedure which would help to receive the reimbursement. To ensure reimbursement, it is critical for the radiology practice to check whether the patient is covered for the particular procedure, whether he/she has run out of benefits or not, and whether the insurance has expired.

Read our blog on why proper documentation is critical for radiology billing and coding success .

Reducing errors when filling out medical claims can result in improved compliance and reduced audit risk for your practice. Before starting the medical coding for radiology reports, check whether the report is complete with heading, number of views or sequences, clinical indications, body or findings of report, impression or conclusion, physician signature and diagnostic studies.

Radiology Coding Tips

• Check for the correct number of views on the report. Radiology dictations often do not include the correct number of views. Coders have to count the number of views and select the corresponding CPT® code. It is critical that the number of views claimed meets the basic requirements of the CPT® code reported. However, to describe those views in the exam, medical coders should be familiar with the abbreviations and terminology used. For instance, in a knee exam even if the radiologist dictates only anteroposterior, lateral, and oblique views on a knee, the coder must be skilled enough to realize that the radiologist took both left and right oblique views, making it a four-view study.
• When reporting a complete abdominal ultrasound using CPT code 76700, make sure that the physician’s report indicates all areas such as – liver, gallbladder, common bile duct, pancreas, spleen, kidneys, upper abdominal aorta, and inferior vena cava. If all these areas are not documented, use the code for limited abdominal ultrasound – CPT 76705.
• Remember that for using HCPCS code G0297 which is “Low dose CT scan (LDCT) for lung cancer screening,” patients should meet certain criteria such as – should be within 55 to 77 years of age, have no signs of lung cancer, have a 30-pack year or greater history of tobacco smoking, are current smokers, or have quit within the last 15 years.
• While reporting mammogram for undiagnosed mass or nodule, use the appropriate code to indicate the location, by breast and quadrant, of the mass or nodule. While ICD-10 unspecified codes such as “N63.0”, “N63.10” or “N63.20” are getting denied by carriers, it is recommended to use codes such as
• N63.11 unspecified lump in the right breast, upper outer quadrant
• N63.14 unspecified lump in the right breast, lower inner quadrant
• N63.21 unspecified lump in the left breast, upper outer quadrant
• N63.24 unspecified lump in the left breast, lower inner quadrant
• For infant x-rays, most insurance carriers are denying CPT codes 73592 and 73092 for children over the age of 1. These codes do not indicate specific ages. To avoid denials, providers must consider the age of the patient. If the patient is one year or older, it is important for providers to order, explicitly document and ensure that the acquired images effectively show the anatomy.
• Never code conditions listed as “Rule out”, “Possible”, “Probable”, or “Suspected”, unless they are proven to exist. Also, if the radiology exam is done because of pain, trauma or swelling, state the location with the right code.
• Check whether the radiology exam you are coding has a Local Coverage Determination (LCD) or a National Coverage Determination (NCD). While the CMS has developed NCDs for Medicare coverage of most services and supplies, for services without an NCD, Medicare administrative contractors have developed their own LCDs. Coders should make sure to review national and local policies and take care that the ICD-10 code selected is listed for the particular exam or procedure they are billing.
• Include additional modifiers if needed. Radiology procedures include both technical and professional components, which can be documented in claims such as modifier 26 for professional component, and modifier TC for technical component. Coders should check the current National Correct Coding Initiative (NCCI) edits to decide whether a modifier is necessary. Common modifiers include:
• Modifiers LT Left side and RT Right side to indicate laterality
• Modifier 59 Distinct procedural service (or X(EPSU) modifiers)
• Modifiers 76 Repeat procedure by same physician and modifier 77 Repeat procedure by another physician
• Modifier 50 Bilateral procedure
• Note if there is a contrast or not. Based on the CPT coding guidelines for Radiology, the contrast is administered by any of the following types of injection – Intravascular (into a vein or artery), Intra-articular (into a joint) or Intrathecal (into the spine). Make sure to code MRI and CT exams with contrast, without contrast, or with and without contrast. Also, do not count Oral/Rectal Administration as contrast.

Consider radiology medical coding services offered by AAPC-certified radiology coding specialists, to reduce coding errors and thus improve your practice revenue with appropriate reimbursement.

Meghann Drella possesses a profound understanding of ICD-10-CM and CPT requirements and procedures, actively participating in continuing education to stay abreast of any industry changes.

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Basics of Radiology Coding and Billing

• June 12, 2024
• by StreamlineMD

In the intricate world of healthcare, radiology plays a pivotal role in diagnosis and treatment. However, behind the scenes, a complex coding and billing system ensures healthcare providers receive proper compensation for their services. Understanding the basics of radiology coding and billing is crucial for healthcare professionals and patients. This guide will delve into the fundamentals of radiology coding and billing, shedding light on key concepts and best practices.

Understanding Radiology Coding

Radiology coding involves assigning alphanumeric codes to procedures and services provided by radiologists and radiologic technologists. These codes communicate to insurance companies the specific services rendered during a patient’s visit. Proper coding ensures accurate reimbursement and compliance with regulatory requirements. Here are some essential points to grasp:

1. CPT Codes

Current Procedural Terminology® (CPT) codes, maintained by the American Medical Association (AMA), are used to describe medical, surgical, and diagnostic services. In radiology, CPT codes denote procedures such as X-rays, MRIs, CT scans, PET scans, Mammograms, Nuclear Medicine treatments, Ultrasound examinations, and image-guided Interventional procedures.  There are over 11,000 CPT codes to choose from, and of all medical specialties, there are more CPT codes applicable to radiology than any other specialty.

2. Modifiers

Modifiers are additional two digit alpha-numeric codes appended to the primary CPT code to provide more specific information about the procedure. They may indicate professional services only, left or right anatomy, multiple procedures performed, the use of contrast material, or whether the service was provided at a facility or non-facility location.

3. ICD-10 Codes

International Classification of Diseases, 10th Revision (ICD-10) codes classify diseases, injuries, and health conditions. Radiology reports must include ICD-10 diagnosis codes to justify the medical necessity of the imaging study. When the United States transitioned from ICD-9 to ICD-10 in 2015, the ICD code list expanded from approximately 11,000 3 to 5-character numeric codes to approximately 68,000 3 to 7-character alpha-numeric codes today. This change added significant complexity to coding rules and was very disruptive to the healthcare industry.

See Radiology Coding and Interventional Radiology Coding to learn more.

Radiology Billing Process

Efficient billing is essential for maintaining the financial health of radiology practices. The billing process involves several steps, from verifying patient insurance coverage to submitting claims and reconciling payments. Here’s an overview of the billing process:

1. Patient Registration and Insurance Verification

Upon scheduling an appointment, patients provide demographic information and insurance details. Staff members verify insurance coverage to determine patient eligibility and benefits.

2. Charge Capture

During the patient encounter, healthcare providers document the services provided, including radiology procedures, with corresponding CPT and ICD-10 codes.  Be sure to reconcile the patient demographic records, radiology reports, and the radiology department day log to ensure all patients seen in the department on any given day have a matching and accurate patient demographic record and radiology report to prevent lost revenue.

3. Claim Submission

After charge capture, billing staff compile the necessary information and submit claims to insurance companies electronically or via paper forms. Claims must adhere to specific formatting and coding guidelines to avoid rejection.

4. Adjudication and Payment

Insurance companies review claims for accuracy and medical necessity before processing payments. This step may involve pre-authorization requirements and appeals for denied claims.  Insurance companies will remit payment with an explanation of benefits (EOB) that explains what was paid or not paid, and why.  Most of the payments and benefits information is transmitted electronically today, via electronic funds transfer (EFT) and electronic remittance advice (ERA), but a smaller percentage is still mailed via US Postal Services.

5. Denied Claims Review and Appeals

Insurance companies routinely deny claims for various reasons including lack of medical necessity, lack of prior authorization, lack of patient eligibility, procedure bundling, etc.  Many of these denied claims can be successfully appealed and paid.  Doing so requires carefully reading the reason for the denial and writing a letter to the insurance company with a compelling argument explaining why the claim is valid and should be paid.  It is often important to attach supporting documents such as the physician’s report to the appeal to be successful.  See Basics of Radiology Coding and Appealing Radiology Denials to learn more.  Also, check out this short Radiology Billing Denials video clip to understand the potential value of an effective radiology denial appeals process.

6. Patient Billing and Collections

Once insurance payments are received, patients are billed for any remaining balances, such as copayments, deductibles, or coinsurance. Timely and accurate billing statements facilitate prompt payment collection.

7. Stay Informed

Since Federal, state, local, and payer regulations are continuously changing, stay current by joining industry societies such as the American College of Radiology (ACR), Society of Interventional Radiology (SIR), Outpatient Endovascular & Interventional Society (OEIS), and Radiology Business Managers Association (RBMA).  These organizations regularly publish updates and best practices applicable to radiology coding and billing performance.

Compliance and Regulations

Compliance with healthcare regulations, such as the Health Insurance Portability and Accountability Act (HIPAA), the Office of the Inspector General (OIG), and the Affordable Care Act (ACA), is paramount in radiology coding and billing. Failure to comply with regulations can result in severe penalties, including fines and legal consequences.

Best Practices for Radiology Coding and Billing

To optimize revenue and ensure compliance, radiology practices should adopt the following best practices:

• Regular training and education for staff on coding updates and regulatory changes.
• Implementing modern radiology information systems (RIS) or electronic health record (EHR) systems for accurate documentation and streamlined billing processes.
• Transmitting source documents including radiology reports, patient demographics, and radiology department day logs via electronic HL-7 format to prevent delayed or lost revenue.
• Conducting regular source document reconciliation and claims audits to identify coding errors and billing discrepancies.
• Utilizing coding and billing software, and artificial intelligence (AI) when appropriate, to increase automation and reduce manual errors.
• Appealing denied claims with effective techniques that make compelling arguments the payers will understand.
• Establishing clear communication channels between providers, billing staff, and patients to address billing inquiries promptly.
• Stay informed about radiology coding and billing regulatory changes and industry trends through participation in professional radiology associations, conferences, and educational seminars.

Radiology coding and billing are integral components of the healthcare revenue cycle, requiring meticulous attention to detail and adherence to regulatory guidelines. By understanding the fundamentals of radiology coding and billing, healthcare providers can ensure proper reimbursement for services rendered while maintaining compliance with industry standards. Continuous education, technological advancements, and adherence to best practices are essential for navigating the complexities of radiology billing and ensuring the financial stability of healthcare organizations.

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Diagnosis Radiology Coding Guidelines

This blog first appeared on RadRx .

With radiology services coming under intense scrutiny for medical necessity, it is more important than ever to ensure that documentation for radiology exams is complete. This includes ensuring that diagnosis coding is done in accordance with the official coding guidelines and the Center for Medicare & Medicare Services (CMS) policy.

Although many claims are being paid when initially submitted, post payment reviews are resulting in providers having to return monies to Medicare and other third-party payers. This can be avoided with a proper medical necessity screening process.

The right medical necessity screening process ensures that all pertinent clinical information is received prior to a service being rendered. It also verifies compliance in coding practices after an exam is performed and documented.

1. Document Review for Determining Diagnosis Code

There are two key documents for review. Although each is a viable source document for selecting a diagnosis code for the encounter, utilizing only one of these two documents to select procedure and diagnosis codes can result in unnecessary coding compliance risks for any provider of services.

• Test order with accompanying signs/symptoms
• Radiology report containing the final written interpretation

At first glance it may appear that diagnosis coding for diagnostic radiology exams is straightforward, it actually can be quite challenging. In many cases, the documentation that must be reviewed prior to assigning a diagnosis code may be unavailable, unclear or contradictory.

2. The Diagnostic Test Order

An encounter for radiology services begins with a test order from the referring (ordering physician) which is then taken to an imaging center, hospital or other provider of diagnostic imaging services.

A complete and accurate test order is crucial to coding compliance because payment for services by Medicare is made only for those services that are reasonable and necessary. Furthermore, CMS charges the referring physician with the responsibility of documenting medical necessity as part of the Medicare Conditions of Participation (42 CFR 410.32).

The Balanced Budget Act of 1997 reiterates this requirement in Section 4317(b) where it states that the ordering physician must provide signs/symptoms or a reason for performing the test at the time it is ordered. If the referring physician indicates a “rule out”, he/she must also include signs/symptoms prompting the exam for ruling out that condition.

In the event this information is missing, the ordering physician should be contacted for this information before proceeding with the exam.

Since medical necessity is determined by those signs/symptoms provided by the ordering physician, it is vital to have this information at the time of final coding even when the radiology report identifies and abnormal finding or condition. This information is key in helping to determine whether or not a finding is incidental or related to the presenting signs/symptoms.

Furthermore, a test ordered to “rule out” a specific condition is considered a screening exam in the eyes of Medicare and would need to be coded as such in the absence of documented signs/symptoms, with a screening code assigned as the primary diagnosis and any findings assigned as additional diagnoses.

3. The Radiology Report

While the test order may determine medical necessity and initially drive the encounter, review of the final radiology report holds the key to determining the correct diagnosis codes for an encounter.

Radiology reports contain four main sections:

• clinical indications
• summary of findings
• impression and final interpretation

The clinical indications listed on the report should be those signs or symptoms provided by the referring physician that prompted the ordering of the test .

The radiologist’s final interpretation, the impression, may list multiple conditions and is the final piece of the puzzle in choosing a primary diagnosis code.

Additionally, careful review of the clinical indications will help determine whether or not certain conditions mentioned in the findings section, or in the impression, are clinically significant or simply incidental findings.

4. Choosing the Primary Diagnosis

The ICD-10-CM Official Guidelines for Outpatient Coding and Reporting contains guidelines specific to patients receiving diagnostic services only:

“For patients receiving diagnostic services only during an encounter/visit, sequence first the diagnosis, condition, problem, or other reason for encounter/visit shown in the medical record to be chiefly responsible for the outpatient services provided during the encounter/visit. Codes for other diagnoses (e.g., chronic conditions) may be sequenced as additional diagnoses.

For encounters for routine laboratory/radiology testing in the absence of any signs, symptoms, or associated diagnosis, assign Z01.89. Encounter for other specified ICD-10-CM Official Guidelines for Coding and Reporting FY 2018 Page 110 of 117 special examinations. If routine testing is performed during the same encounter as a test to evaluate a sign, symptom, or diagnosis, it is appropriate to assign both the Z code and the code describing the reason for the non-routine test.

For outpatient encounters for diagnostic tests that have been interpreted by a physician, and the final report is available at the time of coding, code any confirmed or definitive diagnosis(es) documented in the interpretation. Do not code related signs and symptoms as additional diagnoses”.

Coding Rules Summary: Diagnosis Coding for Radiology Exams

Confirmed Diagnosis Based on Results of Test

If the physician has confirmed a diagnosis based on the results of the diagnostic test, the physician interpreting the test should code that diagnosis. The signs and/or symptoms that prompted ordering the test may be reported as additional diagnoses if they are not fully explained or related to the confirmed diagnosis.

Signs or Symptoms

If the diagnostic test did not provide a diagnosis or was normal, the interpreting physician should code the sign(s) or symptom(s) that prompted the treating physician to order the study.

Diagnosis Preceded by Words that Indicate Uncertainty

If the referring physician provides a diagnosis preceded by words that indicate uncertainty (e.g., probable, suspected, questionable, rule out, or working), the uncertain diagnosis should not be coded.

Furthermore, if the results of the diagnostic test are normal or a definitive diagnosis has not been made by the radiologist, signs/symptoms prompting the ordering of the test should be identified and reported.

Diagnoses labeled as uncertain are considered by the ICD ‐ 10 ‐ CM Coding Guidelines as unconfirmed and should not be reported. This is consistent with the requirement to code the diagnosis to the highest degree of certainty.

Incidental Findings

Incidental findings should never be listed as primary diagnoses. If reported, incidental findings may be reported as secondary diagnoses. It is recommended to report any incidental findings that may warrant additional follow-up studies.

Unrelated Coexisting Conditions/Diagnoses

Unrelated and coexisting conditions/diagnoses may be reported as additional diagnoses by the physician interpreting the diagnostic test.

Diagnostic Tests Ordered in the Absence of Signs and/or Symptoms

When a diagnostic test is ordered in the absence of signs/symptoms or other evidence of illness or injury, the testing facility or the physician interpreting the diagnostic test should report the screening code as the primary diagnosis code. Any condition discovered during the screening should be reported as a secondary diagnosis.

Reviewing the Source Documents & Choosing the Primary Dx Code

Armed with the test order, radiology report and all of the coding guidelines, there are a few stages to assembling all of the pieces of the puzzle.

5 Steps for Selecting the Primary Dx Code

• Review the information documented under the “impression” for any definitively diagnosed conditions.
• Review the clinical indications to determine if those conditions listed in the impression are related to the exam, or unrelated incidental findings for the exam ordered. The clinical indications on the report should match those on the order from the referring physician.
• Review the summary of findings in the body of the report if necessary to clarify the diagnostic information provided in the impression. Sometimes this may be helpful in adding specificity for coding a particular condition.

Exercise caution in using information documented only in the summary of findings and not documented in the impression. Often the radiologist will comment on everything that he sees visualized on the images, but not all findings noted are clinically significant for the exam being performed.

• Choose the primary diagnosis code based on the guidelines in the section above title “Choosing the Primary Diagnosis” after considering and determining all pertinent findings in the radiology report.
• Assign diagnosis codes for any other additional pertinent findings. Incidental findings may be coded after all clinically significant findings are reported. Incidental findings are abnormal findings not specifically related to why the exam was performed but discovered during the exam.

A few common examples of findings that might be considered incidental are:

• MRI Brain: Atrophy or ischemic changes in the elderly
• CT Abdomen:  Fatty liver or liver cyst
• CT Pelvis:  Diverticulosis

The following examples illustrate incidental findings:

• A patient is referred for an abdominal ultrasound due to jaundice. After review of the ultrasound, the radiologist discovers the patient has an aortic aneurysm. The primary diagnosis is jaundice and the aortic aneurysm may be reported as a secondary diagnosis.
• A patient is referred for a chest x-ray because of wheezing. The x-ray is normal except for scoliosis and degenerative joint disease of the thoracic spine. The primary diagnosis is wheezing since it was the reason for the patient’s visit. The other findings may be reported as additional diagnoses.
• A patient is referred for an MRI of the lumbar spine with a diagnosis of L-4 radiculopathy. The MRI reveals degenerative joint disease at L1 and L2. The primary diagnosis is radiculopathy and the degenerative joint disease of the spine may be reported as an additional diagnosis.

It should never be assumed that any particular condition is always incidental. What is considered incidental for one patient and one study, may not be considered incidental for another patient and another study. When there is difficulty in determining whether or not a finding is incidental or whether or not it should be reported, it is prudent to query the radiologist.

This blog post first appeared on RadRx .  

Stacie L. Buck, RHIA, CCS-P, RCC, CIRCC, AAPC Fellow

President & Senior Consultant, RadRx

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Top radiology CPT codes at imaging centers

Jan 12th, 2024

Radiologists are a vital part of acute and chronic care teams. These physicians use medical imaging technology —such as x-rays, CT scans, MRIs, and ultrasounds—to diagnose and treat injuries and illnesses in patients.

What are the types of imaging procedures?

Radiology procedures are performed using one or more medical imaging machines, depending on what part of the body or type of diagnostics is needed. Some of the most common procedures include images and/or scans from:

• Angiography
• Computerized tomography (CT)
• Echocardiograph
• Electrocardiogram (EKG)
• Magnetic resonance imaging (MRI)
• Ultrasound (US)

Which CPT codes are used for radiology procedures?

Imaging procedures are captured through the current procedural terminology (CPT) code set, with the radiology CPT code range consisting of codes 70010 to 79999. These codes further break down into the following categories and code ranges:

• Diagnostic imaging: 70010-76499
• Diagnostic ultrasound: 76506-76999
• Radiologic guidance: 77001-77032
• Breast mammography: 77046-77067
• Bone/joint studies: 77071-77092
• Radiation oncology: 77261-77799
• Nuclear medicine: 78000-79999

Using procedure data from the Definitive Healthcare Atlas All-Payor Claims and ImagingView products, we compiled a list of the top radiology CPT procedure codes performed at imaging centers in the U.S. Claims for 2023 through November are used for the analysis.

Top 20 radiology CPT procedure codes

Fig 1. Data from Definitive Healthcare Atlas All-Payor Claims and ImagingView products. Claims data is sourced from multiple medical claims clearinghouses in the United States and updated monthly. Accessed January 2024.

What is the most common radiology CPT code?

CPT code 77067 - screening mammography, bilateral had the most procedures at imaging centers in 2023 through November. In the second spot was an additional breast examine, CPT code 77063 - screening digital breast tomosynthesis, bilateral, which is an advanced type of mammography. These procedures are used to screen patients for breast cancer .

The next two top imaging procedures are chest x-rays, CPT codes 71046 and 71045, often used to diagnose respiratory conditions and/or viruses. Additional common radiology procedures include bone density studies, MRIs of the spinal canal and abdomen, abdomen and pelvis CT scans, and shoulder x-rays.

What is the difference between diagnostic radiology and interventional radiology?

Diagnostic radiology uses medical imaging technology to help determine the cause of patient symptoms. These scans are non-invasive and help physicians see inside a patient’s body without surgery. For example, a patient with pain in their lower abdomen might undergo a CT of their middle body to determine if their appendix is inflamed.

Interventional radiology , on the other hand, uses medical imaging to assist physicians in performing minimally invasive surgeries . These types of procedures allow for smaller and/or fewer incisions, which helps patients recover more quickly. If the patient with abdominal pain had appendicitis, a surgeon could use small cameras to guide their tools and remove the patient’s appendix.

What are the different radiology sub-specialties?

In the Definitive Healthcare PhysicianView product, we track five radiology sub-specialties that include:

• Diagnostic radiology
• Interventional radiology
• Neuroradiology
• Nuclear medicine
• Pediatric radiology

In addition, radiation oncologists are tracked as an oncology sub-specialty .

Learn more

Looking for more information on radiology and imaging procedures and the providers that perform them? Find out which imaging center corporations are the largest or which imaging center performs the most MRIs . And when you are ready to start targeting the right imaging centers for your solution or product, healthcare commercial intelligence from the Definitive Healthcare platform can help guide you. Sign up for a free trial today.

About the Author

Maggy bobek tieché.

Maggy Bobek Tieché has worked with healthcare data for nearly 18 years. Her positions include roles in product management and custom reporting, working with life science,…

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Clinical Examples in Radiology Online Quiz - Summer 2024 A Practical Guide to Correct Coding

Clinical Examples in Radiology (CER) online newsletter is provided for coding professionals to test their knowledge based on review of relevant modern case studies. In this issue learn how to code in the case of a 52-year-old female who undergoes a left breast cyst aspiration with ultrasound guidance. Apply coding techniques in the case of a 21-year-old male with a history of prior urethral injury who had a suprapubic tube placement and presents for a retrograde urethrocystogram. In the documentation challenge, identify the proper codes to report a nuclear lymphangiogram for a 38-year-old female with a history of bilateral mastopexy due to breast cancer. The radiology test in this issue highlights the performance of hepatosplenic scintigraphy for a 64-year-old female who presents with chronic hepatitis. Dive deeper into these cases and challenge your coding skills with the Summer 2024 issue of Clinical Examples in Radiology.

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PB Coding Manager (Radiology) - Remote - 130967

Job description, #130967 pb coding manager (radiology) - remote.

Special Selection Applicants : Apply by 08/07/24. Eligible Special Selection clients should contact their Disability Counselor for assistance.

Candidates hired into this position may have the ability to work remotely.

This position will remain open until filled.

DESCRIPTION

UC San Diego Health's Revenue Cycle department supports the organization's mission to deliver outstanding patient care and to create a healthier world - one life at a time. We are a diverse, patient-focused, high-performing team with a commitment to quality, collaboration, and continuous improvement that enables us to deliver the maximum standard of care to our patients. We offer challenging career opportunities in a fast-paced and innovative environment and we embrace individuals who demonstrate a deep passion for problem-solving and customer service.

The PB Coding Manger, is responsible for ensuring the timely, accurate and compliant coding and charge capture for their assigned group of specialties. The Coding Manager ensures their assigned team(s) complete the assignment of CPT, HCPCS and ICD-10 coding of services rendered by physicians and allied health professionals for inpatient, outpatient and office-based services. The PB Coding Manager is responsible for monitoring and adjusting workflows on a daily basis to ensure services are captured and billed within the established charge lag set forth by the Physician Group.

The PB Coding Manger, has responsibility for monitoring the quality and accuracy of services being coded by their team(s). In collaboration with the Second Level Review (SLR) Team, the Coding Manager will be involved in the regular quality reviews of their team members and will be responsible for providing any necessary education or training identified as appropriate to ensure the ongoing accuracy of charges submitted and to be compliant with all applicable federal, state and payer coding guidelines. The Coding Manager will also be required to assist the coding team with complex surgical cases, and to provide timely feedback to the team and the physicians.

MINIMUM QUALIFICATIONS

Nine (9) years of related coding experience, education and/or training; OR a Bachelor’s Degree in related area plus five (5) years of related coding experience. Related experience: Coding Radiology services.

Solid supervisory and organizational skills. Ability to effectively manage multiple priorities in a fast-paced environment

Thorough knowledge of revenue cycle management practices and concepts, charge master, billing, coding and collection regulations.

Skilled in written and verbal communications, with the ability to effectively motivate others, to convey complex information in a clear and concise manner, and to prepare and present a variety of reports and analyses.

Strong project management skills with the ability to organize, manage multiple priorities, meet deadlines, and delegate assignments efficiently.

In-depth knowledge of all relevant information technology, including systems, tools, applications, processes, and methodologies.

PREFERRED QUALIFICATIONS

Professional fee coding certification, such as CPC or CCS-P.

Will consider RHIT or RHIA with CCS certification.

Must have experience leading remote teams.

Must have at least five (5) years of management experience.

Healthcare environment experience.

Epic and 3M encoder user experience.

SPECIAL CONDITIONS

Must be able to work various hours and locations based on business needs.

Employment is subject to a criminal background check and pre-employment physical.

Pay Transparency Act

Annual Full Pay Range: $94,400 - $176,800 (will be prorated if the appointment percentage is less than 100%)

Hourly Equivalent: $45.21 - $84.67

Factors in determining the appropriate compensation for a role include experience, skills, knowledge, abilities, education, licensure and certifications, and other business and organizational needs. The Hiring Pay Scale referenced in the job posting is the budgeted salary or hourly range that the University reasonably expects to pay for this position. The Annual Full Pay Range may be broader than what the University anticipates to pay for this position, based on internal equity, budget, and collective bargaining agreements (when applicable).

If employed by the University of California, you will be required to comply with our Policy on Vaccination Programs, which may be amended or revised from time to time. Federal, state, or local public health directives may impose additional requirements. If applicable, life-support certifications (BLS, NRP, ACLS, etc.) must include hands-on practice and in-person skills assessment; online-only certification is not acceptable.

UC San Diego Health is the only academic health system in the San Diego region, providing leading-edge care in patient care, biomedical research, education, and community service. Our facilities include two university hospitals, a National Cancer Institute-designated Comprehensive Cancer Center, Shiley Eye Institute, Sulpizio Cardiovascular Center, the only Burn Center in the county, and and dozens of outpatient clinics. We invite you to join our team!

Applications/Resumes are accepted for current job openings only. For full consideration on any job, applications must be received prior to the initial closing date. If a job has an extended deadline, applications/resumes will be considered during the extension period; however, a job may be filled before the extended date is reached.

To foster the best possible working and learning environment, UC San Diego strives to cultivate a rich and diverse environment, inclusive and supportive of all students, faculty, staff and visitors. For more information, please visit UC San Diego Principles of Community .

UC San Diego is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age or protected veteran status.

For the University of California’s Affirmative Action Policy please visit: https://policy.ucop.edu/doc/4010393/PPSM-20 For the University of California’s Anti-Discrimination Policy, please visit: https://policy.ucop.edu/doc/1001004/Anti-Discrimination

UC San Diego is a smoke and tobacco free environment. Please visit smokefree.ucsd.edu for more information.

UC San Diego Health maintains a marijuana and drug free environment. Employees may be subject to drug screening.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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Posted : 9/4/2024

Job Reference # : 130967

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Interested in working at UC San Diego and UC San Diego Health but can't find a position that's right for you? Submit your resume to our Talent Community to be considered for future opportunities that may align with your expertise. Please note, by joining our Talent Community, you are not applying for a position with UC San Diego Campus and Health. Rather, this is an additional way for our Talent Acquisition team to find candidates with specific credentials, if an opportunity arises. You are still encouraged to regularly check back on our career site or sign up for Job Alerts to apply for openings that are a match for your background.

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2021 Anticipated Code Changes

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Several radiology codes and guideline revisions will be implemented beginning January 1, 2021. As in past years, many of the new codes have been created as a result of bundling mandates from the American Medical Association’s (AMA) Relativity Assessment Workgroup (RAW) for the purpose of identifying what it considers potentially “misvalued” services. The RAW required specific codes be referred to the Current Procedural Terminology (CPT®) Editorial Panel for evaluation. This often results in bundling of the codes found to be reported together. For 2021, the referral included percutaneous core needle lung biopsy with imaging guidance.

In addition, two new Category I codes will be introduced to describe medical physics dose evaluation and low-dose computed tomography (CT) of the thorax for lung cancer screening. Category III codes will also be available July 1, 2020 for new procedures, such as irreversible electroporation (IRE) ablation and magnetic resonance spectroscopy (MRS).

Also, there will be significant revisions to the office or other outpatient evaluation and management (E/M) visit codes.

The ACR urges its members to review and consider how the bundled and new code changes may impact their practices.

DIAGNOSTIC RADIOLOGY

Screening CT of Thorax

Expect editorial revisions to the CT of thorax codes 71250, 71260, 71270 specifying these codes are diagnostic. Also, a new CT of thorax code will be available to report low-dose lung cancer screening.

Healthcare Common Procedure Coding System (HCPCS) code G0297 was identified on the Centers for Medicare and Medicaid Services (CMS) high value growth screen and, therefore, was referred to the CPT® Editorial Panel to establish a Category I CPT® code to report low-dose CT for lung cancer screening.

Code 74425 will be editorially revised and a reciprocal parenthetical will be added clarifying that it can be reported with codes 50390, 50396, 50684, and 50690.

Fluoroscopic Guidance 

Codes 64400-64450 and 64455 (introduction/injection of anesthetic agent and/or steroid into the somatic nervous system) were not listed in the inclusionary parenthetical notes following fluoroscopic guidance codes, these codes will be added in the inclusionary parenthetical notes following codes 77002 and 77003.

Ultrasound Follow-up Study

Code 76970 was identified on the RAW’s CMS/Other source codes screen, and therefore referred to the CPT Editorial Panel for deletion due to low volume.

INTERVENTIONAL RADIOLOGY

Percutaneous Core Needle Lung Biopsy

Code 32405 will be deleted and replaced with a new code that bundles percutaneous core needle lung biopsy with imaging guidance, when performed.

Codes 32405 and 77012 were identified by the RAW as code pairs being performed together 75 percent or more of the time, therefore were referred to the CPT® Editorial Panel for bundling.

MEDICAL PHYSICS

Medical Physics Dose Evaluation

Look for a new Category I code in the Radiology, Diagnostic Radiology (Diagnostic Imaging), Other Procedures subsection of the CPT®codebook to report the assessment and calculation of radiation dose and the potential adverse iatrogenic effects received by the patient that may require follow-up observation or treatment. This is a technical component only code as this service is typically performed by a medical physicist.

CATEGORY III

The following codes will be available on July 1, 2020.

Irreversible Electroporation (IRE) Ablation

Anticipate two new Category III codes to be available for reporting irreversible electroporation (IRE) ablation, a new procedure that uses high voltage electrical impulses for the treatment of cancer.

Magnetic Resonance Spectroscopy (MRS)

Four new Category III codes will be available to report magnetic resonance spectroscopy (MRS) for the determination and localization of discogenic spine pain (cervical, thoracic, or lumbar).

EVALUATION AND MANAGEMENT

Office or Other Outpatient Evaluation and Management (E/M) Visit

The CPT® Editorial Panel approved significant revisions of the office or other outpatient visit E/M code descriptors and guidelines for publication in the CPT® 2021 code set. As part of CMS’ initiative to reduce unnecessary documentation requirements, minimize the need for audits, and ensure payment levels for office or other outpatient evaluation and management (E/M) visit codes are resource-based, the AMA convened the CPT® and Specialty Society Relative Value Scale (RVS) Update Committee (RUC) Evaluation and Management (E/M) Workgroup. The Workgroup provided recommendations to the CPT® Editorial Panel based on input by medical specialty societies.

As a result, new patient code 99201 will be deleted and the code descriptors will be editorially revised for codes 99202, 99203, 99204, and 99205, and established patient codes 99211, 99212, 99213, 99214, and 99215. Prolonged services codes 99354, 99355, and 99356 will also be revised to reflect these changes.

There will also be a new add-on code created to report additional physician time in 15-minute increments. This add-on code will be reported in conjunction with codes 99205 and 99215.

Additionally, history and/or physical examination as a component for code selection will be eliminated; code level selection will be based on medical decision making (MDM) or time. There will also be changes in the definition of MDM and time when used with these codes. The E/M guidelines will be revised extensively to reflect these changes.

For detailed information on the office or other outpatient E/M visit 2021code revisions, refer to CPT®Assistant articles:

February 2020 issue: E/M Office Visit Revisions for 2021: An Overview

March 2020 issue: E/M Office or Other Outpatient Visit Revisions for 2021: Time

This summer the Economics & Health Policy eNews section section of the ACR website will post an impact analysis of the 2021 code changes to help radiology and radiation oncology practices prepare for the 2021 changes. In addition, the September/October 2020 issue of the ACR Radiology Coding Source will include a list of the new 2021 codes and descriptors pertinent to radiology.

In August, the AMA will provide an early release of the downloadable version of the CPT 2021 codebook from the AMA Bookstore. The Centers for Medicare and Medicaid Services (CMS) approves values for codes, however, the values will not be known until the Medicare Physician Fee Schedule Final Rule is published in the Federal Register , typically in November of the calendar year before the codes become effective. Be sure to check the complete listing of code changes in the AMA’s CPT 2021 codebook.

Note: The AMA posts a Summary of Panel Actions , which is available for public viewing. To reiterate, while this summary lists the code changes proposed and the actions taken by the CPT Editorial Panel, the AMA cautions that these actions are a reflection of the discussions at the most recent CPT Editorial Panel meetings. Future Editorial Panel actions may affect these items. Note that specific code numbers have not yet been assigned and wording has not been finalized until just prior to publication. The CPT 2020 Data File with specific CPT code set information is scheduled for release in August 2020.