Outpatient Facility Coding Alert

Take note of some important code description revisions.

As is the case with the radiology specialty, this year you’ve got a lot to consider with respect to new, revised, and deleted radiological CPT^® codes.

While it may look like a handful on the surface, you’ll find after closer inspection that these updates are going to be helpful in the long run. Specifically, CPT^® lays out a few practical and useful revisions to existing descriptions that should help to clear up some lingering confusion.

Coder’s note: “Coders must understand the importance of reviewing the revised CPT^® codes the AMA publishes each year — since the result of using a code description that has been revised could be that the claim does not get paid,” says Ronda Tews, CPC, CHC, CCS-P, AAPC Fellow, director of billing and coding compliance at Modernizing Medicine in Boca Raton, Florida. “However, without a review of the code description changes for your specialty each year, the implications could be significantly worse — the claim could get paid when it shouldn’t,” warns Tews. 

Read on to check out all the most important radiology-specific changes to the 2020 CPT^® manual.

Begin With Fundamental Code Description Changes to 74022

As you’ll quickly see, the most fundamental changes to the 2020 radiology CPT^® code set don’t come by way of new or deleted codes, but rather by an array of revisions. On top of that, some revisions aren’t merely replacing one word for another, they are doing a complete overhaul. For instance, have a look at this revision to 74022 (note that the strikethrough outlines the prior description and the underline outlines the revised description):

• 74022 (Radiologic examination, abdomen; complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect, and/or decubitus views), and a single view chest).

The 2019 and prior version of 74022 has been a cause for confusion and headaches — and for good reason. To start, it doesn’t address any abdominal views, so you’re left to your own devices to deduce that only two or more are required. It was easy to falsely assume that since 74021 (Radiologic examination, abdomen; 3 or more views) includes three views of the abdomen, 74022 must also include at least three views. Now you conclusively know that’s not the case. Additionally, the wording did not easily explain whether the single chest view was interchangeable with the three listed abdominal views — or existed as its own separate entity.

Note that if the exam includes two views of the chest rather than one, the chest and abdomen should be separately reported. The two-view chest X-ray would be reported with code 71046 (Radiologic examination, chest; 2 views), and the abdomen X-ray would be reported with code 74019 (Radiologic examination, abdomen; 2 views) or 74021
(…3 or more views) depending on the number of views.

Check out This 74210-74248 Overhaul

The most sweeping changes for the 2020 calendar year (CY) come by way of radiologic examination codes of the pharynx, esophagus, and upper gastrointestinal (GI) tract. Have a look at two important revised code descriptions:

• 74210 (Radiologic examination, pharynx and/or cervical esophagus, including scout neck radiograph(s) and delayed image(s), when performed, contrast (eg, barium) study; pharynx and/or cervical esophagus)
• 74220 (Radiologic examination, esophagus, including scout chest radiograph(s) and delayed image(s), when performed; esophagus single-contrast (eg, barium) study).

“You can see that CPT^® makes a point to outline exactly what each service entails, unlike the descriptions that existed prior to 2020,” says Barry Rosenberg, MD, chief of radiology at United Memorial Medical Center in Batavia, New York. These revised descriptions, along with numerous others in this code range, will prove especially useful to beginning coders who are struggling to wrap their head around the differences between each respective barium swallow study code. Furthermore, CPT® introduces a brand-new indented code to 74220 for the reporting of double contrast studies:

• 74221 (…double-contrast (eg, high-density barium and effervescent agent) study).

Don’t Discount the Power of the Semicolon

Next up, have a look at two fundamental code description revisions for a pair of common GI tract studies:

• 74230 (Swallowing Radiologic examination, swallowing function, with cineradiography/videoradiography, including scout neck radiograph(s) and delayed image(s), when performed, contrast (eg, barium) study)
• 74240 (Radiologic examination, upper gastrointestinal tract, including scout abdominal radiograph(s) and delayed image(s), upper when performed; with or without delayed images single-contrast (eg, without KUB barium) study).

CPT^® elaborates further on what services are involved in swallowing function (also called modified barium swallow) studies. You’ve now got documentation within the code description that 74230 includes scout imaging of the neck along with delayed images, when performed.

Before diving into what the code description revision for 74240 means, you’ll want to have a look at this code deletion for 2020:

• 74241 (with or without delayed images, with KUB).

Instead of reporting a separate code for delayed images and/or KUB, you’re now reporting one universal code (74240) for all single contrast studies of the upper GI tract. Furthermore, have a look at two more related code deletions for 2020:

• 74245 (…with small intestine, includes multiple serial images)
• 74249 (…with small intestine follow-through).

Until 2020, you’d report an upper GI radiologic examination (single or double contrast) with small intestine follow-through using codes 74245 and 74249, respectively. Instead, CPT® introduces a new separate procedure code to report small intestine follow-through studies alongside single or double-contrast exams:

• +74248 (Radiologic small intestine follow-through study, including multiple serial images (List separately in addition to code for primary procedure for upper GI radiologic examination)).

Finally, on the subject of double-contrast radiologic examinations, have a look at this final code description revision:

• 74246 (…with or without delayed images double-contrast (eg, high-density barium and effervescent agent) study, including glucagon, without KUB when administered).

Here, you’ve got to refer back to the base code 74240 to see how 74246 changes. Since the description “including scout abdominal radiograph(s) and delayed image(s)” in 74240 now precedes the semicolon, that portion of the code description is now included in 74246 as well. Similar to the deletion of 74241, this renders the following deleted code obsolete:

• 74247 (…with or without delayed images, with KUB). 

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