Radiology Coding Alert

Check your answers to see if you’re ready for 2022.

Do these major coding changes from 2021 ring a bell?

Before you ring in the new year, see if your answers from the quiz questions on page 3 line up with the ones provided below.

Make Sure to Specify Your Patient’s Low Back Pain

Answer: Several ICD-10-CM codes in the 2022 code set were converted to parent codes. “It appears these codes were converted to parents to help increase specificity. For example, the M54.5- (Low back pain) may be used to perform a spine study,” says Kristen Taylor, CPC, CHC, CHIAP, Associate Partner at Pinnacle Enterprise Risk Consulting Services in Columbia, South Carolina.

ICD-10-CM code M54.5- features three expanded codes to aid in specifying your patient’s condition. Parent code M54.5- carries a 5th character required icon, so you’ll need to select the expanded code that applies to your patient’s diagnosis.

For 2022, you’ll choose from the following codes:

• M54.50 (Low back pain, unspecified)
• M54.51 (Vertebrogenic low back pain)
• M54.59 (Other low back pain)

Additional synonyms: Codes M54.50 and M54.51 each feature additional synonyms that your provider may use in their documentation, including loin pain and lumbago NOS for M54.50 and loin pain and low back vertebral endplate pain for M54.51.

Remember — Local MACs Make the Call on Select PET Scans

Answer: On Nov. 19, 2021, the Centers for Medicare and Medicaid Services (CMS) published the Medicare Physician Fee Schedule (MPFS) final rule. In the document, CMS finalized the removal of certain National Coverage Determinations (NCDs). CMS removed NCD 220.6 Positron Emission Tomography (PET) Scans because they determined the NCD’s removal “better serves the needs of the Medicare program and its beneficiaries.”

By removing the NCD for PET scans for non-oncologic indications, local Medicare Administrative Contractors (MACs) will now have the discretion to make coverage determinations under section 1862(a)(1)(A) of the Social Security Act for beneficiaries. The ability for local MACs to consider coverage “will allow Medicare beneficiaries greater access to PET scans for non-oncologic indications,” says the American College of Radiologists in their statement on the MPFS (URL: www.acr.org/-/media/ACR/Files/Advocacy/2022-MPFS-Final-Rule-Preliminary-Summary.pdf). Additionally, CMS states in the final rule, “the NCDs listed at 220.6.1 through 220.6.20 will not be changed by removing this NCD.”

Check the Descriptors to Find the Differences Between TBS Codes

Answer: New to CPT^® in 2022 are four new codes covering trabecular bone score (TBS) procedures. A TBS is a calculation of bone texture related to the bone microarchitecture, and physicians consider this a marker to determine the risk of osteoporosis. “The main use of a TBS is, in conjunction with measures of bone density, to help better estimate fracture risk in patients who have metabolic bone problems,” says Taylor.

The new TBS codes for 2022 include:

77089 (Trabecular bone score (TBS), structural condition of the bone microarchitecture; using dual X-ray absorptiometry (DXA) or other imaging data on gray-scale variogram, calculation, with interpretation and report on fracture-risk)

• 77090 (…; technical preparation and transmission of data for analysis to be performed elsewhere)
• 77091 (…; technical calculation only)
• 77092 (…; interpretation and report on fracture-risk only by other qualified health care professional)

Assigning the correct TBS CPT^® code comes down to carefully reading the descriptors.

Bonus Answer: In the coding quiz on page 3, we asked a bonus question to see if you know the differences between the new TBS codes. The answer lies in the descriptors.

If your radiologist performs the complete TBS procedure, includes the score calculation, interprets the results, and determines the fracture risk for the patient, you’ll report 77089. However, you’ll code 77090 if the radiologist simply prepares the technical component and transmits the data for analysis at another facility. You’ll assign 77091 to report only the technical calculation for the TBS, but you’ll report 77092 if another qualified healthcare professional (QHP) interprets the score and determines the fracture risk.

Click here to go back to the quiz.