21 Feb 2018

Radiology coding guidelines

Radiology is a division of science that using imaging techniques like x-ray, Ultrasound, MRI/MRA, CT/CTA scan and PET scans to diagnose and treat a health condition.   

       X-ray: A form of electromagnetic radiations and noninvasive procedure that produces the picture of our internal structures in black and white when we expose our part of the body. It is because different body tissues observes a different amount of radiations and the bones have more calcium which absorbs the most.  

      CT scan: Computed Tomography, special X-ray images with combination of computer-processed pictures can be taken in any angle to view the cross-sectional images of the body. 

     CTA: Computed Tomography Angiography, Mainly to study blood vessels. Contrast material is used to get a clear picture of blood vessels. 

     MRI: Magnetic Resonance Imaging, Using a strong magnetic field and radio waves to form a picture of our inner organs/body parts. It’s more safe compare to radiations. 

     MRA: Magnetic Resonance Angiography, for the study of blood vessels.  

     Ultrasound/Sonogram: using sound waves images are being taken to study the soft tissues structures. 

     Doppler/ Duplex scan – To study the blood vessels.  

     PET SCAN: Positron emission tomography scan can procedure multidimensional colour images of the body. A special dye (radioactive tracers) is used to observe the metabolic process in the body.


In CPT book under the Radiology section, Header [Diagnostic Radiology (Imaging)] all the codes are arranged in anatomical order and the sub-headers are starting from       

        1.   Head and Neck

        2.   Chest

        3.   Spine and Pelvis

        4.   Upper Extremities

        5.   Lower Extremities

        6.   Abdomen 

And the codes under each subheader of Diagnostic Radiology is arranged in the following order,






X-Ray CPT Code’s guidelines: 

X-rays codes are arranged like a minimal view to maximum views(stand-alone code followed by one or more intended codes). 

   Eg: For X-Ray Wrist, we have two codes in the CPT book under Radiology Section


          CPT 73100 – Radiological examination of the wrist; 2 views


         CPT 73110 – Radiological examination of the wrist; minimum of 3 views 


A. If a single view of wrist x-ray is performed then append modifier 52 (Reduced service) with CPT 73100 (Because of CPT code description states it's 2 views).


B. If four or more views of wrist x- rays are taken no need to append any modifier with CPT 73110 since the CPT description is stating that it’s minimum of 3 views.


C. If bilateral wrist x- rays are taken then we can code either using modifier 50 (Bilateral procedures modifier) or modifier RT & LT.


    Eg: 73100 – 50




          73100 – RT

          73100 – LT


D. Repeat Procedures: When the same procedure is repeated in the same day then we have two modifier choices either modifier 76 or 77 based on performing physicians.


    -  If the services are performed by the same physician append modifier 76


    -  If the services are performed by the different physician append modifier 77



            Eg: Two views of wrist x-ray performed at 10.00am and the same procedure is repeated at 11.00am by the same physician should be coded like,

                 Ans: 73100, 73100 – 76


            Eg: Two views of wrist x-ray performed at 10.00am and the same procedure is repeated at 11.00am by another physician should be coded like,

                 Ans: 73100, 73100 – 77


E. If both the major and minor views of the same anatomic location are performed on the same day can be billed with modifier 59,  also for the same CPT but different anatomy would be billed with modifier 59 


      Eg: Three views of right wrist x-ray performed at 10.00 am and another two views of the right wrist are performed at 11.00 am (Here anatomical location remains the same but the views are different) append modifier 59 with minimal view procedure code.

         Ans: 73110, 73100 – 59


      Radiologic examination of overlapping anatomic locations like Hand /Fingers and Foot/toes performed in the same day can be billed with modifier 59.


     Eg: Three views of hand and two views of fingers at different timings but on the same day should be coded as

      For hand and fingers 73130, 73140 – 59

      For foot and toes 73630, 73660 - 59


When there is a combination CPT code to describe multiple services performed then no need to code separately.



      X-ray of ribs with chest: CPT 71101 & 71111

      X-ray of hips with pelvis: CPT 73501 – 73523


Modifier 26 and TC are used to denote professional and technical services. 

Note: Selection of X-ray CPT is based only on the number of views (Anterior, Lateral and Oblique etc) taken not by the Pictures or images count.

CT Scan CPT Code’s guidelines

CT scan codes are arranged based on contrast material used or not. First Standalone code would be without contrast study and followed by two intended codes (Second code is for with contrast and the third code would be with and without contrast study)


Eg: CT of Chest

          71250 – CT of Chest, without contrast

          71260 – CT of Chest, with contrast

          71270 – CT of Chest, with and without contrast


We have combination codes for CT of abdomen and pelvis (74176, 74177 & 74178), and individual codes for CT of the abdomen (74150, 74160, 74170) and CT of the pelvis (72192, 72193, 72194). If both the services are performed on the same day report only the combination codes.


If 3D is performed along with CT scan, then report both CT scan & 3D with either CPT 76376 or 76377 based on the requirement of on independent workstation.


Billing guidelines: If the CT scan is performed without using IV contrast and later on the same day one more CT scan of the same anatomical site is repeated using contrast material would be coded as with and without contrast study (Use single CPT which describes both the service).


Contrast material administered via 



       Intra-articular and 

       Intra-thecal is considered a contrast study. 

Contrast administered via the rectal or oral route is not considered as contrast study.


CTA Scan CPT Code’s guidelines

CTA codes are mostly single code following CT codes. All the CTA codes are with contrast study and including image post-processing. Hence 3D codes (76376 / 76377) should not be billed separately.


MRI Scan CPT Code’s guidelines

MRI scan codes are arranged based on contrast material used or not. First Standalone code would be without contrast study and followed by two intended codes (Second code is for with contrast and the third code would be with and without contrast study)


Eg: MRI of brain

            CPT 70551 – MRI of the brain, without contrast

            CPT 70552 – MRI of the brain, with contrast

            CPT 70553 – MRI of the brain, with and without contrast


      One exception is MRI of the spinal canal and contents with and without contrast study, CPT’s are given separately. (CPT 72156, 72157 & 72158)


MRI of the upper extremity and lower extremity, two sets of codes are given for joint and non-joint studies.

    -      Upper extremity non-joint study, arm / forearm (73218 - 73220)

    -      Upper extremity joint study, shoulder / elbow /wrist (73221 - 73223)

    -      Lower extremity non-joint study, thigh / lower leg (73718 - 73720)

    -      Lower extremity joint study, hip / knee / ankle (73721 - 73723)

Note: If the shoulder and elbow of the same extremity is performed on the same day, then append modifier 59 (Distinct procedures) Eg: 73221, 73221 - 59

MRA Scan CPT Code’s guidelines

MRA scan codes are mostly single code following MRI codes; rare cases there are three codes first stand-alone code followed by two intended codes.


Eg: MRA of neck

           CPT 70547 – MRA of the neck, without contrast

           CPT 70548 – MRA of the neck, with contrast

           CPT 70549 – MRA of the neck, with and without contrast


3D codes (76376 / 76377) should not be billed separately along with MRA codes.

Apart from above-mentioned procedures all the surgery-related radiological supervision and interpretation codes are listed out in Radiology sections. As well as the imaging guidance codes are listed in the radiology section (Ultrasound / Fluoroscopic / Computed tomography / Magnetic resonance guidance).

Important imaging guidance CPT’s are

      Ultrasound Guidance – 76937 (Vascular) & 76942 (Non-vascular)

      Fluoroscopic Guidance – 77001 (Vascular), 

                                                         77002 (Non-vascular)  

                                                         77003 (spinal)

     CT Guidance - 77012

     MRI Guidance - 77021

Based on medical documentation we need to assign the most appropriate guidance CPT codes along with surgery codes.


For different anatomic regions that have “complete” and “limited” ultrasound codes. Note the elements that comprise a complete exam. The document should contain all the listed elements or should have a reason that an element could not be seen due to surgically absent or obscured by bowel gas.

If less than the required elements for a complete exam would be reported with limited study code.

Eg: Ultrasound of Abdomen (Require 8 element – Liver, gallbladder, CBD, pancreas, spleen, kidneys, upper abdominal aorta and IVC) to code CPT 76700.

       If a single organ or single quadrant of the abdomen is performed then code CPT 76705

Note: A limited exam of an anatomic region should not be reported along with a complete exam of that same region performed at the same session. If performed at different sessions can bill both the service with modifier 59 to the limited-service CPT.

Eg: complete ultrasound of abdomen followed by limited ultrasound of the abdomen (Appendicitis) on the same day would be coded as 76700, 76705 - 59

Evaluation of vascular structures using both colour and spectral Doppler is reported using appropriate CPT (93880 - 93990) from the Medicine section.

Ultrasound is not reportable if there is no complete evaluation of organ or anatomic region, image documentation and final written report.

Ultrasound of Bladder

We should not report CPT 76775 (Retroperitoneal Ultrasound) for Bladder ultrasound. Actually, the bladder is located in pelvis; hence we need a select the limited pelvis ultrasound study code (CPT 76857).

If both kidneys and bladder are performed to R/o urinary tract pathology then we should code CPT 76770 (US, retroperitoneal, complete).

Pelvic ultrasound 

CPT's 76801, 76805, 76811, 76815, 76817

In CPT manual there are two different sets of codes for Obstetrical and Non-Obstetrical under Pelvis, OB is mainly for pregnant ladies and the Non-Ob codes can be used for both female and male pelvis examination. Based on the elements listed out in the CPT manual we need to select the appropriate complete or limited codes.  

Reference: http://www.codingprime.in/2018/03/how-to-code-ob-ultrasound-cpts-76801.html


Starting from Jan 2018 all the “G” codes related to Digital Mammography procedures are removed and going forward we need to use only the CPT’s 77065, 77066 and 77067 which includes the CAD (computer-aided detection) service.

         CPT selection is based on whether screening (or) Diagnostic studies.

  Modifier GH and GG

     A. If the patient scheduled for screening and the physician found some abnormality then he converts the screening into a diagnostic procedure. We should bill only the diagnostic mammogram with modifier “GH” (Bill only the Diagnostic CPT with GH)

    B. If the patient scheduled for screening and the physician performed screening procedure found some abnormality then he performs one more procedure (Diagnostic Mammogram) in the same day append modifier GG with the diagnostic study. (Bill both screening and Diagnostic mammogram CPTs with modifier GG)


DEXA SCAN: Codes 77080 (Axial skeleton) and CPT 77081 (Appendicular skeleton) bone density study (Mainly they perform for Osteoporosis conditions)

      T-score of -1.0 to -2.5 = Osteopenia

      T-score of -2.5 or below = Osteoporosis

RADIATION ONCOLOGY -  http://www.codingprime.in/2017/07/radiation-oncology-coding-guidelines.html 


Nuclear Medicine is a branch of medicine that deals with the use of radioactive substances to diagnose or treat a health condition.

Important words to differentiate the Nuclear Medicine section CPT’s

      Limited: One area

      Multiple: Two or more areas

      Whole-body: Head to Toe

      SPECT (Single-photon emission computed tomography)

     Three-phase study (Flow phase / Blood pool phase / Delayed phase)

            A. Flow phase – Images are obtained 1 min after injection

            B. Blood poop phase – Images are obtained after 5 min injection

            C.  Delayed phase – Images are obtained after 2-4 hours with some images after 24 hrs.

Note: Few procedures are performed over multiple days (Spot or delayed / same or next day) should not be coded for each individual days. CPT descriptions should be watched carefully.

To perform some procedures Drugs is used (with Pharmacological study)

      Eg: Hepatobiliary Imaging – CCK (Cholecystokinin)

             Kidney or Brain imaging – Lasix

PET SCAN – Positron emission tomography sometimes combined with CT scan (78811-78816)

HIDA Scan – Hepatobiliary iminodiacetic acid scan / Cholescintigraphy / Hepatobiliary scintigraphy / Hepatobiliary scan (78226 – 78227)

MUGA Scan – Multigated acquisition scan create the videos of lower chambers of the heart to check whether they are pumping the blood properly.  (CPT 78472 - 78473)

                           Stress – Treadmill walking/cycling / drug-induced

Lymphoscintigraphy – CPT 78195

Octreotide Scan – A type of scintigraphy to find tumours (CPT 78800 - 78804


Test your Knowledge:

            A. Radiology CPC Sample Quiz