Radiology (CPT® Coding): CPC Tips – MEDES

“Radiology is won on four reads: how many views, who owns the equipment (26 vs TC vs global), whether the guidance is bundled into the procedure, and whether the study was complete or limited. Read the setting and the descriptor before you ever pick a code.”

— MEDESUN Coding Principle

How to Analyze a Radiology CPC Question

Radiology questions turn on views, components (26/TC), guidance, and contrast. Four answers usually differ by one of those. Work them in order.

CPC EXAM TIPS

• Step 1 — Read the last sentence first. CPT® only, ICD-10-CM only, or both? Whose service — professional, technical, or global?
• Step 2 — Name the modality & body area. Plain X-ray, fluoroscopy, ultrasound, CT, MRI, mammography, nuclear medicine, interventional/vascular, or radiation oncology.
• Step 3 — Count the views / decide complete vs limited. Plain films are chosen by number of views; ultrasounds by complete vs limited.
• Step 4 — Decide the component. 26 = professional (read only, facility/hospital/ASC, physician doesn’t own equipment); TC = technical (equipment owner); no modifier = global (office, does both).
• Step 5 — Handle guidance & contrast. Is the imaging guidance bundled into the procedure or separately reportable? Is the study without, with, or without and with contrast?
• Step 6 — Work the diagnosis & sequencing last. Suspected ≠ coded (outpatient); for a radiation-only visit, sequence 0 first; screening uses a Z-code.

The Golden Rule — Index, Then Verify; Read the Setting

• Never code from the CPT® Index alone — confirm views, contrast, and inclusions in the numeric section and read the subsection guidelines (e.g., what makes an abdominal ultrasound “complete”).
• S&I (radiologic supervision and interpretation) is the imaging read — it is separate from the procedure/injection. Many procedures have a parenthetical note pointing to the matching S&I code (e.g., intraoperative cholangiography → 74300).
• Plain-film codes are chosen by the number of views — always count them in the stem. For best medical coding training in Hyderabad visit MEDESUN

Components: 26, TC, or Global (most-tested)

KEY RULES

• Modifier 26 (professional component): the physician reads/interprets but does not own the equipment — used in the hospital, ASC, or other facility
• Modifier TC (technical component): the equipment owner (e.g., an IDTF) reports the technical service.
• Global (no modifier): the same provider/site performs and interprets the study — typical of the physician office.
• Some codes are facility-only or component-exempt:g., SBRT delivery 77371–77373 are facility-only — do not append 26 or TC.

Example — Two-view tibia/fibula X-ray read by a hospital radiologist

• Tibia/fibula, two views → 73590; physician reads only in the hospital → add -26.

How to Eliminate Wrong Answers — Chapter 17 Knockouts

CPC EXAM TRAPS

• View-count knockout: delete the plain-film code whose number of views doesn’t match the stem (e.g., chest 71045 = 1 view vs 71046 = 2 views).
• Component knockout: delete -26 in the office (global), and delete a global/TC answer when only the read is provided in a facility (needs 26).
• Guidance-bundled knockout: delete a separate guidance code when the procedure includes it (paracentesis 49083 includes guidance; renal cryoablation 50250 includes US guidance; PET includes the FDG injection).
• Guidance-modality knockout: match the right guidance — ultrasound 76942, fluoroscopy 77002, CT 77012, MRI 77021 — and append 26 when it’s the read only.
• Contrast knockout: delete the wrong contrast option — without vs with vs without and with.
• Complete-vs-limited knockout: one organ examined → limited (e.g., gallbladder-only abdominal US = 76705, not the complete 76700).
• Screening-vs-diagnostic knockout: asymptomatic → screening code + Z-code (mammo 77067 + Z12.31); symptoms/history → diagnostic.
• S&I-separate knockout: delete answers that omit the S&I read when a procedure + interpretation are both documented (e.g., cholangiogram → 74300-26).
• Sequencing/suspected knockout (ICD): delete answers that code a suspected condition (outpatient) or that fail to sequence 0 first for a radiation-therapy-only encounter.

Radiology Rules You Must Know

Plain Films, Fluoroscopy & Contrast

• Count views for plain films (chest 71045–71048; hand min-3-views 73130; ankle 2-view 73600). Foreign-body search films exist even when no FB is found (e.g., 76010 nose-to-rectum).
• Contrast matters: CT/MRI codes split by without / with / without and with — read the stem exactly.

Ultrasound — Complete vs Limited, and Guidance

• Complete requires all the organs/elements in the subsection guideline; one organ = limited (abdomen 76700 vs 76705; retroperitoneum 76770 vs 76775).
• OB ultrasound (read the notes above 76801): 76801 < 14 wks / 76805 ≥ 14 wks (+ add-ons per extra fetus), 76815 limited, 76816 follow-up, 76811 detailed, 76818 BPP includes NST (don’t add 59025).
• US guidance — needle placement 76942, vascular access 76937 (needs documented patency + permanent images).

Mammography, DXA, CT Colonography & PET

Study  |  Code / Rule

• Mammography —  Screening 77067 (CAD included) · diagnostic 77065 unilateral / 77066 bilateral · 3-D add-ons +77063 / +G0279
• CT colonography —  Screening 74263 · diagnostic 74261/74262
• DXA bone density —  Axial (hips/pelvis/spine) 77080 · appendicular 77081
• PET-CT —  By anatomic range (78815 skull base–mid thigh · 78816 whole body); FDG injection bundled

Interventional / Vascular & Nuclear Medicine

• Catheter placement + S&I: nonselective aorta 36200 + serialography S&I (e.g., 75630); central venous access 36556/36558 + guidance 76937/77001.
• Nuclear medicine scales by extent: thyroid metastatic limited 78015 (+uptake 78020 only if done); bone marrow 78102/78103/78104; V/Q lung 78582 (ventilation + perfusion).

Radiation Oncology

• Delivery levels: Level 1 77402 Level 2 77407 · Level 3 77412 (by areas/ports/blocking). SBRT delivery 77373 (≤5 fractions, facility-only).
• Management is the physician’s oversight, reported per 5 fractions (77427). Brachytherapy by source count (simple/intermediate/complex, 77761–77763). For Radiology Coding Training and clear CPC Exam, visit www.medesunglobal.com

Dr. M. Santosh Kumar Guptha, Founder and CEO of MEDESUN, is a first-generation CPC Training, AHIMA-Approved ICD-10 Trainer with over 22 years of experience and a rare command of both AAPC and AHIMA credentialing domains. A published author and respected industry voice, he has trained 30,000+ coders globally and built proprietary programs like the CAIMC® credential and CodersGrade® internship. His mission is simple: produce coders who understand the medicine behind the code.