Part B Insider (Multispecialty) Coding Alert

Plus: 36251-36254 Create a New Coding World for Renal Angiography

CPT® 2012 updates are hot off the press. Here's an overview of the Radiology Section revisions, including brand new CTA and nuclear medicine codes.

Combine 72191 and 74175 Under 74174

Starting Jan. 1, 2012, you'll benefit from new code 74174 (Computed tomographic angiography, abdomen and

pelvis, with contrast material[s], including noncontrast images, if performed, and image postprocessing).

This serves as a combination of services described by 74175 (Computed tomographic angiography, abdomen, with contrast material[s], including noncontrast images, if performed, and image postprocessing) and 72191 (Computed tomographic angiography, pelvis, with contrast material[s], including noncontrast images, if performed, and image postprocessing).

Use new code 74174 only for same-session abdomen/pelvis CTA. Just as in 2011, if you're coding only a CTA abdomen, you'll report 74175; if you're coding a CTA pelvis only, look to 72191.

Line Up 78226 and 78227 for Hepatobiliary Imaging

Also in the Radiology Section, you'll find that CPT® eradicates 78220 (Liver function study ...) and 78223 (Hepatobiliary ductal system imaging ...) and replaces them with the following new codes:

• 78226, Hepatobiliary system imaging, including gallbladder when present
• 78227, ...with pharmacologic intervention, including quantitative measurement(s) when performed.

Prepare for Pulmonary Shake Up

Rounding out the Radiology Section changes, you'll find a vast overhaul of the respiratory imaging section, with pulmonary perfusion and ventilation codes 78584-78596 deleted and 78580 revised to say "Pulmonary perfusion imaging (e.g., particulate)." In place of the deleted codes, you'll find the following:

• 78579, Pulmonary ventilation imaging (e.g., aerosol or gas)
• 78582, Pulmonary ventilation (e.g., aerosol or gas) and perfusion imaging
• 78597, Quantitative differential pulmonary perfusion, including imaging when performed
• 78598, Quantitative differential pulmonary perfusion and ventilation (e.g., aerosol or gas), including imaging when performed.

Include Imaging in 6463x

CPT® 2012 replaces 64622-64627 (Destruction by neurolytic agent, paravertebral facet joint nerve ...) with a new range of codes that include imaging guidance:

• 64633, Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint
• +64634, ... cervical or thoracic, each additional facet joint (List separately in addition to code for primary procedure)
• 64635, ... lumbar or sacral, single facet joint
• +64636, ... lumbar or sacral, each additional facet joint (List separately in addition to code for primary procedure).

Toss Out Old Renal Angiography Options

In revising renal angiography code options, CPT® creates codes that include catheter placement, imaging, and more:

• 36251, Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral
• 36252, ... bilateral
• 36253, Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheterization, fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral
• 36254, ... bilateral.

Simplify IVC Filter Coding

In 2011, you used component coding for inferior vena cava (IVC) filter insertion and had to make do with less than optimal code choices for filter removal. In 2012, you'll have all-in-one codes specific to insertion, repositioning, and removal of these filters:

• 37191, Insertion of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed
• 37192, Repositioning of intravascular vena cava filter ...
• 37193, Retrieval (removal) of intravascular vena cava filter ...