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Cross Coder

Essential links from CPT® codes to ICD-9-CM and HCPCS codes

2013 00 RCC TOC.fm Page 1 Friday, N ovem ber 18, 2011 4:30 PM

Contents

Introduction...... i Other Radiologic Guidance ...... 452 Format ...... i , ...... 454 Icon Key ...... ii CPT Codes ...... ii / Studies ...... 457 Code Links ...... iii ICD-9-CM Diagnostic Codes ...... iii Radiation ...... 467 ICD-9-CM Procedure Codes ...... iv Clinical Treatment Planning (External and Internal Sources) ...... 467 HCPCS Level II Codes ...... iv Medical Radiation Physics, Dosimetry, Summary ...... vii Treatment Devices, and Special Services ...... 467 Diagnostic Radiology (Diagnostic Imaging) ...... 1 Stereotactic Radiation Treatment Delivery ...... 478 Head and Neck ...... 1 Radiation Treatment Delivery ...... 480 Chest ...... 70 Neutron Beam Treatment Delivery ...... 486 Spine and Pelvis ...... 86 Radiation Treatment Management ...... 489 Upper Extremities ...... 184 Beam Treatment Delivery ...... 489 Lower Extremities ...... 220 Hyperthermia ...... 490 Abdomen ...... 266 Clinical Intracavitary Hyperthermia ...... 492 ...... 284 Clinical Brachytherapy ...... 493 Urinary Tract ...... 310 Nuclear ...... 503 Gynecological and Obstetrical ...... 328 Diagnostic—Endocrine System...... 503 ...... 330 Diagnostic—Hematopoietic, Reticuloendothelial, Vascular Procedures ...... 335 and Lymphatic System...... 504 Other Procedures ...... 382 Diagnostic—Gastrointestinal System...... 511 Diagnostic ...... 386 Diagnostic—Musculoskeletal System...... 520 Head and Neck...... 386 Diagnostic—Cardiovascular System...... 524 Chest ...... 398 Diagnostic—Respiratory System...... 548 Abdomen and Retroperitoneum ...... 399 Diagnostic—Nervous System...... 552 Spinal Canal ...... 404 Diagnostic—...... 566 Pelvis ...... 406 Diagnostic—Other Procedures...... 569 Genitalia ...... 437 Therapeutic...... 569 Extremities ...... 439 Glossary...... 571 Ultrasonic Guidance Procedures ...... 440 Other Procedures ...... 448 Table...... 579

Radiologic Guidance ...... 451 Fluoroscopic Guidance ...... 451 Computed Guidance ...... 451 Magnetic Resonance Guidance ...... 452

© 2011 Optum CPT © 2011 American Medical Association. All Rights Reserved. Introduction

OptumInsight is pleased to present the 2012 Radiology Cross Coder. Format The popularity of similar publications, such as Surgical Cross Coder, An understanding of this book’s format allows users to easily indicates that a one-stop reference for radiology codes is valuable to navigate its content. Information within the main section ties to the coders. Fully comprehensive, Radiology Cross Coder links more than CPT book and the codes are presented in the same numeric order as 600 CPT radiology codes to corresponding ICD-9-CM diagnosis, the radiology section. ICD-9-CM procedure, CPT , and HCPCS Level II codes. OptumInsight believes that professional coders working in Sections offices, clinical outpatient, , as well as payer Radiology Cross Coder provides linked information to the CPT code settings will embrace this reference. range 70010 to 79999. The codes are divided into the same sections and subsections as the radiology section of the CPT book. Radiology Cross Coder is based on the radiology section of Current For example, the diagnostic radiology section is further divided into Procedural Terminology® (CPT). Up-to-date CPT radiology codes anatomical subsections, such as head and neck, spine and pelvis, link to the following related medical coding systems: and abdomen. There are also sections for diagnostic ultrasound, • International Classification of Diseases, 9th Revision, Clinical radiation oncology, and . Modification (ICD-9-CM) Codes and Code Ranges •. Healthcare Common Procedure Coding System (HCPCS) The data within each CPT code set of Radiology Cross Coder is presented as follows: All coding relationships in Radiology Cross Coder start with the • CPT code or code range surgery section of the CPT book presenting a general clinical picture of each surgery code. Pertinent radiology-related coding • CPT codes and descriptions relationships were carefully reviewed and screened for appropriate • CPT cross codes and descriptions information. • ICD-9-CM diagnostic codes and descriptions Certain radiology procedures such as chest x-rays are performed for • ICD-9-CM procedural codes and descriptions almost any diagnosis and are simply too numerous to list. In such instances, the associated diagnoses do not appear in Radiology Cross •. HCPCS Level II codes and descriptions Coder. For a discussion on secondary diagnosis codes, see the ICD-9-CM section later in this introduction. For example: Some CPT codes are omitted from the listing because consistent 70380 and reliable cross-links are almost impossible to establish. Unlisted 70380 Radiologic examination, salivary gland for calculus procedure codes are an obvious example. Certain types of add-on codes are also treated somewhat differently. These codes are Associated CPT Codes discussed in greater detail under the CPT Codes section later in this N/A introduction. Unlisted and add-on codes are listed with full ICD-9-CM Diagnostic descriptions in appendixes at the end of this publication. 526.9 Unspecified disease of the jaws As a coding reference, Radiology Cross Coder presents “most likely” 527.5 Sialolithiasis scenarios as derived from clinical information sources. However, 527.8 Other specified diseases of the salivary glands Radiology Cross Coder is not a substitute for ICD-9-CM, or any other 527.9 Unspecified disease of the salivary glands medical coding reference, and users are urged to regularly consult 784.2 Swelling, mass, or lump in head and neck all available sources. The absence of any specific code does not ICD-9-CM Procedural necessarily indicate that its association to the base procedure code is 87.09 Other soft tissue x-ray of face, head, and neck inappropriate. Assuming all rules of radiology coding are followed, HCPCS Level II Supplies & Services excepted diagnosis codes may prove appropriate to a specific code R0070 Transportation of portable x-ray equipment and scenario. personnel to home or home, per trip to facility Radiology Cross Coder does not include coding rules or guidelines. or location, one patient seen Once again, the user is urged to consult the original coding R0075 Transportation of portable x-ray equipment and reference (e.g., CPT, ICD-9-CM, HCPCS Level II, etc.) or one of personnel to home or nursing home, per trip to facility several reputable medical coding instruction manuals. or location, more than one patient seen

© 2011 Optum CPT © 2011 American Medical Association. All Rights Reserved. i Radiology Cross Coder 73085

782.2 Localized superficial swelling, mass, or lump V54.20 Aftercare for healing of arm, unspecified 2 812.40 Closed fracture of unspecified part of lower end of humerus 2 V54.21 Aftercare for healing pathologic fracture of upper arm 812.50 Open fracture of unspecified part of lower end of humerus 2 V67.4 Treatment of healed fracture follow-up examination 813.08 Closed fracture of radius with ulna, upper end (any part) ICD-9-CM Procedural 813.18 Open fracture of radius with ulna, upper end (any part) 88.22 Skeletal x-ray of elbow and forearm 813.47 Torus fracture of radius and ulna 818.0 Ill-defined closed fractures of upper limb 818.1 Ill-defined open fractures of upper limb 73085 73085 Radiologic examination, elbow, arthrography, radiological supervision and interpretation 829.0 Closed fracture of unspecified bone 2 832.00 Closed unspecified dislocation of elbow Associated CPT Codes 832.01 Closed anterior dislocation of elbow 24220 Injection procedure for elbow arthrography 832.02 Closed posterior dislocation of elbow ICD-9-CM Diagnostic 832.03 Closed medial dislocation of elbow 710.1 Systemic sclerosis — (Use additional code to identify manifestation: 359.6, 517.2) 832.04 Closed lateral dislocation of elbow 711.32 Postdysenteric arthropathy, upper arm — (Code first underlying disease: 002.0-002.9, 832.09 Closed dislocation of other site of elbow 008.0-009.3) E 832.10 Open unspecified dislocation of elbow 2 711.92 Unspecified infective , upper arm 2 832.11 Open anterior dislocation of elbow 714.0 Rheumatoid arthritis — (Use additional code to identify manifestation: 357.1, 359.6) 832.12 Open posterior dislocation of elbow 715.12 Primary localized osteoarthrosis, upper arm 832.13 Open medial dislocation of elbow 715.22 Secondary localized osteoarthrosis, upper arm 832.14 Open lateral dislocation of elbow 715.32 Localized osteoarthrosis not specified whether primary or secondary, upper arm 832.19 Open dislocation of other site of elbow 715.92 Osteoarthrosis, unspecified whether generalized or localized, upper arm 2 832.2 Nursemaid's elbow 716.02 Kaschin-Beck disease, upper arm 841.8 Sprain and strain of other specified sites of elbow and forearm 716.12 Traumatic arthropathy, upper arm 841.9 Sprain and strain of unspecified site of elbow and forearm 2 716.22 Allergic arthritis, upper arm 881.01 Open wound of elbow, without mention of complication 716.32 Climacteric arthritis, upper arm ; 881.11 Open wound of elbow, complicated 716.82 Other specified arthropathy, upper arm 905.2 Late effect of fracture of upper extremities 716.92 Unspecified arthropathy, upper arm 2 923.10 Contusion of forearm 718.02 Articular disorder, upper arm 923.11 Contusion of elbow 718.12 Loose body in upper arm joint 923.9 Contusion of unspecified part of upper limb 2 718.82 Other joint derangement, not elsewhere classified, upper arm 927.9 Crushing of unspecified site of upper limb — (Use additional code to identify 719.02 Effusion of upper arm joint any associated : 800-829, 850.0-854.1, 860.0-869.1) 2 719.42 Pain in joint, upper arm 959.3 Injury, other and unspecified, elbow, forearm, and wrist 719.52 Stiffness of joint, not elsewhere classified, upper arm 996.40 Unspecified mechanical complication of internal orthopedic device, implant, and graft 719.62 Other symptoms referable to upper arm joint — (Use additional code to identify prosthetic joint with mechanical complication, 719.82 Other specified disorders of upper arm joint V43.60-V43.69) 2 719.92 Unspecified disorder of upper arm joint 2 996.41 Mechanical loosening of prosthetic joint — (Use additional code to identify prosthetic 726.30 Unspecified enthesopathy of elbow 2 joint with mechanical complication, V43.60-V43.69) 726.31 Medial epicondylitis of elbow 996.42 Dislocation of prosthetic joint — (Use additional code to identify prosthetic joint with mechanical complication, V43.60-V43.69) 726.32 Lateral epicondylitis of elbow 996.43 Broken prosthetic joint implant — (Use additional code to identify prosthetic joint with 726.33 Olecranon bursitis mechanical complication, V43.60-V43.69) 726.39 Other enthesopathy of elbow region 996.44 Peri-prosthetic fracture around prosthetic joint — (Use additional code to identify 729.90 Disorders of soft tissue, unspecified 2 prosthetic joint with mechanical complication, V43.60-V43.69. 729.99 Other disorders of soft tissue 996.45 Peri-prosthetic osteolysis — (Use additional code to identify prosthetic joint with 782.2 Localized superficial swelling, mass, or lump mechanical complication, V43.60-V43.69. Use additional code to identify major osseous 841.0 Radial collateral ligament sprain and strain defect, if applicable: 731.3) 841.1 Ulnar collateral ligament sprain and strain 996.46 Articular bearing surface wear of prosthetic joint — (Use additional code to identify 841.2 Radiohumeral (joint) sprain and strain prosthetic joint with mechanical complication, V43.60-V43.69) 841.3 Ulnohumeral (joint) sprain and strain 996.47 Other mechanical complication of prosthetic joint implant — (Use additional code to 841.8 Sprain and strain of other specified sites of elbow and forearm identify prosthetic joint with mechanical complication, V43.60-V43.69) 841.9 Sprain and strain of unspecified site of elbow and forearm 2 996.49 Other mechanical complication of other internal orthopedic device, implant, and graft 923.11 Contusion of elbow — (Use additional code to identify prosthetic joint with mechanical complication, 927.9 Crushing injury of unspecified site of upper limb — (Use additional code to identify V43.60-V43.69) any associated injuries: 800-829, 850.0-854.1, 860.0-869.1) 2 996.66 and inflammatory reaction due to internal joint prosthesis — (Use additional 959.3 Injury, other and unspecified, elbow, forearm, and wrist code to identify specified . Use additional code to identify infected prosthetic V67.4 Treatment of healed fracture follow-up examination joint: V43.60-V43.69) 996.67 Infection and inflammatory reaction due to other internal orthopedic device, implant, ICD-9-CM Procedural and graft — (Use additional code to identify specified infections) 88.32 Contrast 996.77 Other complications due to internal joint prosthesis — (Use additional code to identify complication: 338.18-338.19, 338.28-338.29) HCPCS Level II Supplies & Services A4641 Radiopharmaceutical, diagnostic, not otherwise classified 996.78 Other complications due to other internal orthopedic device, implant, and graft — (Use additional code to identify complication: 338.18-338.19, 338.28-338.29) Q9951 Low osmolar contrast material, 400 or greater mg/ml iodine concentration, per ml V43.62 Elbow by other means Q9958 High osmolar contrast material, up to 149 mg/ml iodine concentration, per ml V54.11 Aftercare for healing traumatic fracture of upper arm Q9959 High osmolar contrast material, 150-199 mg/ml iodine concentration, per ml

© 2011 Optum 2 Unspecified code E Manifestation code CPT only © 2011 American Medical Association. All Rights Reserved. ; Female diagnosis : Male diagnosis 193 Radiation Oncology

141.4 Malignant neoplasm of anterior two-thirds of tongue, part unspecified 2 Clinical Treatment Planning (External and 141.5 Malignant neoplasm of junctional zone of tongue Internal Sources) 141.6 Malignant neoplasm of lingual tonsil 141.8 Malignant neoplasm of other sites of tongue 141.9 Malignant neoplasm of tongue, unspecified site 2 77261-77263 142.0 Malignant neoplasm of parotid gland 77261 Therapeutic radiology treatment planning; simple 142.1 Malignant neoplasm of submandibular gland 77262 intermediate 142.2 Malignant neoplasm of sublingual gland 77263 complex 142.8 Malignant neoplasm of other major salivary glands ICD-9-CM Diagnostic 142.9 Malignant neoplasm of salivary gland, unspecified 2 This code is too broadly diagnostic to adequately present ICD-9-CM diagnostic code links here. 143.0 Malignant neoplasm of upper gum Refer to the Neoplasm Table located in the back of this book. 143.1 Malignant neoplasm of lower gum ICD-9-CM Procedural 143.8 Malignant neoplasm of other sites of gum 92.29 Other radiotherapeutic procedure 143.9 Malignant neoplasm of gum, unspecified site 2 144.0 Malignant neoplasm of anterior portion of floor of mouth 77280-77299 144.1 Malignant neoplasm of lateral portion of floor of mouth 77280 Therapeutic radiology simulation-aided field setting; simple 144.8 Malignant neoplasm of other sites of floor of mouth 77285 intermediate 144.9 Malignant neoplasm of floor of mouth, part unspecified 2 77290 complex 145.0 Malignant neoplasm of cheek mucosa 77295 3-dimensional 145.1 Malignant neoplasm of vestibule of mouth 77299 Unlisted procedure, therapeutic radiology clinical treatment planning 145.2 Malignant neoplasm of hard palate ICD-9-CM Diagnostic 145.3 Malignant neoplasm of soft palate This code is too broadly diagnostic to adequately present ICD-9-CM diagnostic code links here. 145.4 Malignant neoplasm of uvula Refer to the Neoplasm Table located in the back of this book. 145.5 Malignant neoplasm of palate, unspecified 2 ICD-9-CM Procedural 145.6 Malignant neoplasm of retromolar area 92.29 Other radiotherapeutic procedure 145.8 Malignant neoplasm of other specified parts of mouth 145.9 Malignant neoplasm of mouth, unspecified site 2 Medical Radiation Physics, Dosimetry, 146.0 Malignant neoplasm of tonsil 146.1 Malignant neoplasm of tonsillar fossa Treatment Devices, and Special Services 146.2 Malignant neoplasm of tonsillar pillars (anterior) (posterior) 146.3 Malignant neoplasm of vallecula 77300 146.4 Malignant neoplasm of anterior aspect of epiglottis 77300 Basic radiation dosimetry calculation, central axis depth dose calculation, TDF, NSD, 146.5 Malignant neoplasm of junctional region of oropharynx gap calculation, off axis factor, tissue inhomogeneity factors, calculation of non-ionizing 146.6 Malignant neoplasm of lateral wall of oropharynx radiation surface and depth dose, as required during course of treatment, only when 146.7 Malignant neoplasm of posterior wall of oropharynx prescribed by the treating physician 146.8 Malignant neoplasm of other specified sites of oropharynx ICD-9-CM Diagnostic 146.9 Malignant neoplasm of oropharynx, unspecified site 2 This code is too broadly diagnostic to adequately present ICD-9-CM diagnostic code links here. 147.0 Malignant neoplasm of superior wall of nasopharynx Refer to the Neoplasm Table located in the back of this book. 147.1 Malignant neoplasm of posterior wall of nasopharynx ICD-9-CM Procedural 147.2 Malignant neoplasm of lateral wall of nasopharynx 92.29 Other radiotherapeutic procedure 147.3 Malignant neoplasm of anterior wall of nasopharynx 147.8 Malignant neoplasm of other specified sites of nasopharynx 77301 147.9 Malignant neoplasm of nasopharynx, unspecified site 2 77301 Intensity modulated radiotherapy plan, including dose-volume histograms for target 148.0 Malignant neoplasm of postcricoid region of hypopharynx and critical structure partial tolerance specifications 148.1 Malignant neoplasm of pyriform sinus 148.2 Malignant neoplasm of aryepiglottic fold, hypopharyngeal aspect ICD-9-CM Diagnostic 148.3 Malignant neoplasm of posterior hypopharyngeal wall 140.0 Malignant neoplasm of upper lip, vermilion border 148.8 Malignant neoplasm of other specified sites of hypopharynx 140.1 Malignant neoplasm of lower lip, vermilion border 148.9 Malignant neoplasm of hypopharynx, unspecified site 2 140.3 Malignant neoplasm of upper lip, inner aspect 149.0 Malignant neoplasm of pharynx, unspecified 2 140.4 Malignant neoplasm of lower lip, inner aspect 149.1 Malignant neoplasm of Waldeyer's ring 140.5 Malignant neoplasm of lip, inner aspect, unspecified as to upper or lower 2 149.8 Malignant neoplasm of other sites within the lip and oral cavity 140.6 Malignant neoplasm of commissure of lip 149.9 Malignant neoplasm of ill-defined sites of lip and oral cavity 140.8 Malignant neoplasm of other sites of lip 150.0 Malignant neoplasm of cervical esophagus 140.9 Malignant neoplasm of lip, vermilion border, unspecified as to upper or lower 2 150.1 Malignant neoplasm of thoracic esophagus 141.0 Malignant neoplasm of base of tongue 150.2 Malignant neoplasm of abdominal esophagus 141.1 Malignant neoplasm of dorsal surface of tongue 150.3 Malignant neoplasm of upper third of esophagus 141.2 Malignant neoplasm of tip and lateral border of tongue 150.4 Malignant neoplasm of middle third of esophagus 141.3 Malignant neoplasm of ventral surface of tongue

© 2011 Optum 2 Unspecified code E Manifestation code CPT only © 2011 American Medical Association. All Rights Reserved. ; Female diagnosis : Male diagnosis 467