Radiology Coding Alert

Look out for these important revisions, deletions, and bundling mandates.

As is the annual expectation with the radiology specialty, CPT^®’s anticipated 2019 radiological code changes are vast and far-reaching.

While CPT^® may incorporate some of these changes for the sake of sheer practicality, you will find that most changes are the result of the American Medical Association’s (AMA) Relativity Assessment Workgroup (RAW) bundling mandates.

Begin your preparations for 2019 early by getting a head start on these crucial anticipated CPT^® changes in diagnostic, interventional radiology, and more.

Learn the AMA’s Process for Determining Revisions, Deletions, and Additions

Sometimes, it feels like coding changes to the CPT^® manual seemingly come at random. However, the AMA actually has a precise formula in place to help make these determinations.

“Each year the AMA’s Relativity Assessment Workgroup evaluates potential mis-valued codes to determine whether two codes are performed together at least 75 percent of the time,” says Amanda Corney, MBA, medical billing operations manager for Medical Resources Management in Rochester, New York. “If two codes are typically performed in conjunction with one another, a single combination code that more accurately depicts the services may be created,” Corney explains.

In other words, the AMA identifies code pairs that providers of a given specialty perform together 75 percent of the time or more. In these instances, the AMA suggests that CPT^® bundles these procedures into one combination code.

Prep for 9 New FNA Bundled Codes

One of the most important incoming shifts from 2018 will be to the current set of fine needle aspiration (FNA) codes. In addition to a revision to 10021 (Fine needle aspiration; without imaging guidance), code 10022 (Fine needle aspiration; with imaging guidance) will be deleted. In its place will come an assortment of nine new codes, which bundle FNA procedures with radiological supervision and interpretation.

So, instead of reporting 10022 with 76942 (Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation) for US-guided FNA procedures, you will opt for one of the nine new FNA codes that bundles both services together.

Check Out these New-Look Breast MRI Codes

Next up is a set of important changes that will result in the deletion of codes 77058 (Magnetic resonance imaging, breast, without and/or with contrast material(s); unilateral), 77059 (Magnetic resonance imaging, breast, without and/or with contrast material(s); bilateral), and +0159T (Computer-aided detection, including computer algorithm analysis of MRI image data for lesion detection/characterization, pharmacokinetic analysis, with further physician review for interpretation, breast MRI [List separately in addition to code for primary procedure]). In their place will be four new codes: two to report for breast MRIs with and without contrast, respectively, and two codes to report for breast MRIs with computer aided detection (CAD).

Gear Up for a New Knee Arthrography Code, Other Dx Services

RAW designated code 27370 (Injection of contrast for knee arthrography) as a potentially misvalued service due to the fact that coders often incorrectly report it as an arthrocentesis or aspiration. RAW instead suggests that 27370 be deleted and replaced with, according to the American College of Radiology, “a new code to report the injection procedure for knee arthrography or CT/MRI knee arthrography.”

Lastly, for diagnostic radiology, you will want to be on the lookout for some fundamental changes to ultrasound elastography (USE), magnetic resonance elastography (MRE), and contrast enhanced ultrasound (CEUS) codes.

Ready Yourself for New PICC Bundles and More IR Changes

With respect to interventional radiology, the most important switch comes on the front lines of peripherally inserted central catheter (PICC) coding. First, you can expect two new PICC codes that will bundle PICC line procedures with all radiological supervision and interpretation components.

Additionally, you will find important changes to the coding parentheticals for codes 36568 (Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump; younger than 5 years of age), 36569 (… age 5 years or older)) and 36584 (Replacement, complete, of a peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, through same venous access).

Finally, you should prepare for procedural code changes for gastrostomy tube replacements and dilation of the urinary tract procedures. CPT^® will also introduce two new category III codes for bone density ultrasounds and positron emission tomography (PET) absolute quantitation myocardial blood flow.

For a complete list of anticipated CPT^® changes for 2019, you may visit: https://www.acr.org/Advocacy-and-Economics/Coding-Source/March-April-2018/ CPT-2019-Anticipated-Code-Changes.