Apply Radiology Supervision Rules - Certified Professional Coder CPC

1. A surgeon performs a percutaneous needle biopsy of the liver using CT guidance. The operative note documents both the biopsy procedure and the CT guidance. How are these services reported?
   Answer: The biopsy code and the CT guidance code (77012) are reported separately CPT® 77012 covers computed tomography guidance for needle placement (e.g., biopsy, aspiration, injection, localization device). When CT guidance is used for a needle biopsy, both the procedure code (the biopsy) and the CT guidance code are reported separately. CT guidance is not automatically bundled into percutaneous needle procedures — it is a separately identifiable service requiring its own code.
2. A radiologist reads a portable chest X-ray performed in the ICU by a technologist employed by the hospital. The radiologist bills for the interpretation only. Which modifier is required?
   Answer: -26 When a radiologist provides only the interpretation and report of an imaging study and does not own the equipment or perform the technical component, modifier -26 (professional component) is appended to the X-ray code. The hospital bills -TC for the equipment and technologist component. For portable studies performed in the ICU, the technical component belongs to the facility and the professional component to the interpreting radiologist.
3. A radiologist performs the radiological supervision and interpretation for a percutaneous transluminal coronary angioplasty (PTCA). The interventional cardiologist performs the catheterization and the angioplasty. Which statement correctly describes the S&I coding in this scenario?
   Answer: No S&I code is reported for PTCA — imaging is bundled into the cardiac intervention codes Coronary intervention codes (e.g., 92920–92944 for PTCA, stenting) are cardiac catheterization-based codes that include the imaging and guidance components. Unlike peripheral vascular interventions that use separate S&I codes from the 75000 series, coronary intervention codes include the angiographic guidance as an integral component. Separate S&I codes are not reported for coronary interventions.
4. A physician performs image-guided tumor ablation of a renal mass using CT guidance. How is the CT guidance reported relative to the ablation procedure?
   Answer: CT guidance (77013) is reported separately from the ablation procedure code CPT® 77013 covers CT guidance for parenchymal tissue ablation and is reported in addition to the ablation procedure code. Unlike fluoroscopic guidance for vascular interventions (which is often bundled), CT guidance for ablation procedures is separately reportable. Both the ablation code and 77013 are reported to fully capture the service provided.
5. A radiologist supervises and interprets a myelogram of the lumbar spine, including injection of contrast via lumbar puncture. How many codes are reported?
   Answer: One code captures the entire myelogram CPT® 62302 covers myelography via lumbar injection, including radiological supervision and interpretation — a combination code that captures both the injection procedure and the imaging S&I in a single code. Current CPT® myelography codes (62302–62305) are comprehensive: 62302 = lumbar; 62303 = cervical; 62304 = thoracic; 62305 = two or more regions. Unlike older coding conventions that required separate injection and S&I codes, a second separate S&I code is not reported when a current myelography combination code is used.
6. A radiologist performs a diagnostic arthrogram of the left shoulder by injecting contrast under fluoroscopic guidance and then interprets the fluoroscopic images. How many CPT® codes are reported for this service?
   Answer: Two codes — one for the injection procedure and one for the radiological supervision and interpretation A shoulder arthrogram requires two codes: the injection procedure code (e.g., 23350 for the shoulder joint injection with arthrographic contrast) and the radiological S&I code (e.g., 73040 for radiological examination, shoulder, arthrography, radiological supervision and interpretation). The injection and the imaging interpretation are separately coded components of the arthrogram service.
7. A radiologist interprets a fluoroscopic upper GI series performed by a radiologic technologist. The radiologist provides the interpretation and written report but did not operate the fluoroscope. How is the radiologist's service reported?
   Answer: With modifier -26 for the professional (interpretation) component only The radiologist who interprets and reports a study without performing the technical component reports the code with modifier -26 (professional component). The facility reports the technical component (-TC). This applies to all radiological procedures where the professional and technical components are split between providers or entities. The radiologist's modifier -26 reflects the interpretation and report only.
8. A radiologist interprets a complete abdominal ultrasound and documents evaluation of the liver, gallbladder, common bile duct, pancreas, spleen, kidneys, and aorta. Which CPT® code covers a complete abdominal ultrasound?
   Answer: 76700 CPT® 76700 covers ultrasound, abdominal, real time with image documentation, complete — which includes evaluation of the liver, gallbladder, common bile duct, pancreas, spleen, kidneys, upper abdominal aorta, and inferior vena cava. Code 76705 is a limited abdominal ultrasound. Code 76770 is a complete retroperitoneal ultrasound; 76775 is a limited retroperitoneal. Documenting all required elements is necessary to report the complete study code.
9. A radiologist performs a limited abdominal ultrasound because the patient could not tolerate a full examination, evaluating only the gallbladder and common bile duct. Which CPT® code is appropriate?
   Answer: 76705 CPT® 76705 covers a limited abdominal ultrasound — a single organ or quadrant, or follow-up study, when not all elements of a complete study are performed or documented. When clinical circumstances or patient tolerance prevent a complete evaluation, the limited code (76705) must be reported. Reporting the complete code (76700) when not all required elements were evaluated would constitute overcoding.
10. A physician uses ultrasound guidance for a central venous catheter placement and documents the imaging in the medical record, including a permanent record of the image. Which CPT® code covers ultrasound guidance for vascular access procedures?
    Answer: 76937 CPT® 76937 covers ultrasound guidance for vascular access, including documentation of final catheter position using permanent recording of the image. This is the correct code for ultrasound-guided vascular access procedures (e.g., CVC placement). Code 76942 covers ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection); 77002 is fluoroscopic guidance for needle placement.
11. A CT scan of the chest is performed with contrast material. The radiologist notes that the study was done "with and without contrast" in the impression. However, the order only specified "with contrast." Which code is reported?
    Answer: Report the "with contrast only" code based on what was ordered and performed The procedure code must reflect what was actually performed and documented, based on the order and the imaging protocol used. If the study was ordered and performed with contrast only, the "with contrast" code is reported — not the "with and without" code. The radiologist's impression should be verified against the imaging protocol. Reporting a higher-level code without clinical support constitutes upcoding.
12. A catheter is placed into the right common carotid artery. The radiologist then performs angiography of the right carotid artery and right vertebral artery from the same catheter position. How are the S&I codes reported?
    Answer: Two separate S&I codes — one for the carotid and one for the vertebral — as each vessel studied is separately coded Radiology S&I codes for angiography are reported per vessel studied, not per catheter position. Each distinct vessel that is selectively catheterized or studied is separately reported with its own S&I code. The carotid angiography and vertebral angiography are different vessels requiring separate S&I codes, even if the catheter was not repositioned between studies. This reflects the separate radiological interpretation required for each vessel.
13. A radiologist performs radiological supervision and interpretation for a diagnostic carotid artery angiogram following catheter placement by a surgeon. The surgeon reports the catheter placement code. Which CPT® code range covers carotid angiography supervision and interpretation?
    Answer: 75650–75680 CPT® codes 75650–75680 cover extracranial cerebrovascular angiography supervision and interpretation, including carotid and vertebral arteries. Code 75650 covers cervicocerebral (carotid/vertebral) angiography S&I, including any follow-up angiography; 75671 covers bilateral carotid angiography. These S&I codes are reported by the radiologist separately from the catheter placement codes reported by the interventionalist.
14. A radiologist performs both the technical and professional components of a bilateral screening mammogram in a hospital-based outpatient department. How is this billed?
    Answer: The radiologist reports 77067-26; the hospital reports 77067-TC In a hospital outpatient setting, the technical component belongs to the hospital and the professional component (interpretation) belongs to the radiologist. The hospital submits 77067-TC (or without modifier on the UB-04) for the technical component. The radiologist submits 77067-26 on the CMS-1500 for the interpretation and report. The global code is only reported when one entity provides both components (e.g., a private imaging center).
15. A radiologist provides fluoroscopic supervision and interpretation for needle placement during a percutaneous bone biopsy. Which CPT® code covers fluoroscopic guidance for needle placement?
    Answer: 77002 CPT® 77002 covers fluoroscopic guidance for needle placement procedures, including biopsy, aspiration, injection, and localization device placement. When a radiologist provides real-time fluoroscopic supervision specifically for guiding a needle to a target site, 77002 is the appropriate code. Code 77001 is specific to fluoroscopic guidance for central venous access device placement; 77003 is for spine or paraspinous procedures; 77012 covers CT guidance, not fluoroscopy.
16. A physician performs a lumbar epidural steroid injection under fluoroscopic guidance. Which CPT® code correctly captures this procedure with imaging guidance included?
    Answer: 62323 — lumbar or sacral epidural injection, with imaging guidance (fluoroscopy or CT) CPT® 62323 covers injection of a diagnostic or therapeutic substance (including steroid), epidural or subarachnoid, lumbar or sacral region, with imaging guidance (fluoroscopy or CT). The imaging guidance is integral to 62323 — a separate fluoroscopic guidance code (77003) is not additionally reported. Code 62322 covers the same procedure without imaging guidance. Code 62320 is for cervical or thoracic epidural injections without imaging guidance. When fluoroscopy is documented for a lumbar ESI, 62323 is the complete and correct code.
17. A radiologist performs fluoroscopic guidance for a nephrostomy catheter placement. In this scenario, who reports the fluoroscopic guidance code?
    Answer: The radiologist who provided fluoroscopic supervision The radiologist who provides fluoroscopic guidance and documents the supervision and interpretation reports the S&I code. CPT® 74425 covers urinary tract, introduction of contrast material for retrograde ureteropyelography; for nephrostomy tube placement guidance, 74485 (or 77002 for fluoroscopic guidance) is used. The procedural code (nephrostomy placement) is reported by the interventionalist. S&I codes belong to the supervising/interpreting radiologist.
18. A radiologist performs a diagnostic aortogram and bilateral iliofemoral runoff angiogram during the same session. The study includes a complete evaluation of the abdominal aorta and bilateral lower extremity vessels. Which CPT® code covers the supervision and interpretation of this complete abdominal aortogram?
    Answer: 75630 CPT® 75630 covers aortography, abdominal plus bilateral iliofemoral lower extremity, with serialography — the comprehensive code for an aortogram that includes bilateral runoff. Code 75625 covers abdominal aortography alone, without the bilateral lower extremity component. Code 75600 covers thoracic aortography; 75710 covers angiography of an extremity vessel. When the study includes both the abdominal aorta and bilateral iliofemoral runoff, 75630 is the correct and only code needed.
19. A radiologist supervises and interprets a fluoroscopic guidance procedure for a central venous catheter placement performed by a surgeon. The radiologist provides only the supervision and interpretation. Which modifier does the radiologist append to the imaging guidance code?
    Answer: -26 Modifier -26 (Professional Component) is appended by the radiologist when providing only the supervision and interpretation of an imaging guidance procedure. The technical component (equipment operation, staffing) is performed by the facility or another entity. When a radiologist interprets imaging without owning the equipment, -26 is required to identify the professional component only.
20. A vascular surgeon performs a percutaneous transluminal angioplasty of the right iliac artery under fluoroscopic guidance. In addition to the interventional procedure code, how is the fluoroscopic guidance component reported?
    Answer: It is bundled into the angioplasty code per CPT® guidelines for interventional vascular procedures For interventional vascular procedures such as angioplasty, fluoroscopic guidance (including road-mapping and image documentation) is considered integral to the procedure and is bundled into the primary intervention code. The CPT® code for peripheral transluminal angioplasty (e.g., 35473) includes the imaging guidance as a component. Reporting fluoroscopic guidance separately constitutes unbundling for these specific procedures.

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