Radiology Coding Alert

As the American Medical Association (AMA) announces CPT Changes for 2001 this month in Chicago, radiology coders will notice significant modifications to diagnostic, therapeutic, and supervision and interpretation codes. A review of the revisions indicates that most of them are intended to make life simpler for radiology coders.

The AMA has changed a lot of wording for clarification and added some important codes, explains Cindy Parman, CPC, CPC-H, co-owner of Coding Strategies Inc., an Atlanta-based firm that supports 1,000 radiologists and 350 physicians from other specialty areas. Its good news for radiology coders, since virtually all of the changes seem useful.

Among the most noteworthy changes are:

clarification of breast biopsy codes,

addition of vertebroplasty codes,

addition of computerized tomography (CT) angiography codes,

modification of designation for number of views taken,

reorganization of magnetic resonance (MR) angiography codes for the head and neck,

addition of with, without, and without followed by with contrast codes for magnetic resonance imaging (MRI), and

addition of endovascular repair of abdominal aortic aneurysm (AAA) codes.

The modifications will take effect Jan.1, 2001, for Medicare, although it may take longer for other carriers to adopt them. It would be wise for radiology practices and coders to work closely with carriers to determine when to begin implementing the new codes, Parman notes.

Breast Biopsy Codes

There have been a lot of doubts about how to best code specific breast biopsy procedures, Parman says, but CPT Codes 2001 addresses this. There will be little question in the future about which code to assign. There will be a code for percutaneous procedures without imaging and percutaneous procedures with imaging, along with the open incisional codes.

Current codes include 19100 (biopsy of the breast; needle core, [separate procedure]), to describe the percutaneous procedure without imaging, and 19101
( incisional), to describe the open surgical procedure.

These two will be augmented by the following new codes, which describe guidance biopsies and device-assisted biopsies with imaging:

19102 biopsy of breast; percutaneous, needle core, using imaging guidance,

19103 biopsy of breast; percutaneous, automated
vacuum assisted or rotating biopsy device, using imaging guidance.

In addition, CPT 2001 includes a new code to describe image guidance for clip placement during a breast biopsy (19295, image guided placement, metallic localization clip, percutaneous, during breast biopsy [list separately in addition to code for primary procedure]). This code will be used with 19102 and 19103, says Parman. Its an important addition, but just because you can now report this service with a clearly defined code, it doesnt mean youll get paid. I believe there will be attempts to inappropriately bundle this with the procedure codes.

Vertebroplasty Codes

Another addition to the CPT manual are codes to describe vertebroplasty the absence of which has caused concern among coders for a long time.

Although payers have considered it investigational, vertebroplasty has long been clinically accepted as a proven method of treatment, says Gary Dorfman, MD, FACR, FSCVIR, past president of the Society for Cardiovascular and Interventional Radiology (SCVIR) and president of Health Care Value Systems in North Kingstown, Pa., which provides practice management services as well as revenue optimization techniques through coding and billing support. The addition of the new codes indicates that CPT has caught up with clinical practice in this area.

The new vertebroplasty procedural codes include: 22520 (percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic), 22521
( lumbar), and +22522 ( each additional thoracic or lumbar vertebral body [list separately in addition to code for primary procedure]). These will be augmented by radiology codes 76012 (radiological supervision and interpretation, percutaneous vertebroplasty, per vertebral body; under fluoroscopic guidance) and 76013 ( under CT guidance).

Guidance Codes

CPT 2001 also updates guidance codes to add consistency among fluoroscopic, ultrasound and CT guidance (see story on thoracentesis and paracentesis, page 85). Code 76003 will be modified to read: fluoroscopic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), while 76360 will be revised to read: computerized tomography guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), radiological supervision and interpretation. Current code 76934 (ultrasonic guidance for thoracentesis or abdominal paracentesis, radiological supervision and interpretation) will be deleted, as will code 76938 (ultrasonic guidance for cyst [any location] or renal pelvis aspiration, radiological supervision and interpretation]). Coders will be referred to the revised code 76942 (ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) in the future.

In addition, CPT will add a code to describe magnetic resonance guidance as a companion to the codes describing fluoroscopy, ultrasound and CT guidance. The new code is 76393 (magnetic resonance guidance for needle placement [e.g., for biopsy, needle aspiration, injection, or placement of localization device], radiological supervision and interpretation).

These are positive changes that unify these guidance services and provide directions for the appropriate use of these codes in conjunction with certain services, such as ultrasound guidance during placement of central lines, says Dorfman.

Other deletions include 71036 (needle biopsy of intrathoracic lesion, including follow-up films, fluoroscopic localization only, radiological supervision and interpretation) and 76365 (computerized tomography guidance for cyst aspiration, radiological supervision and interpretation).

In addition, ultrasound guidance codes are now designated as imaging supervision and interpretation, as opposed to radiological supervision and interpretation because there are instances when professionals other than radiologists may use them.

Magnetic Resonance Angiography Codes

Radiology coders will also have new magnetic resonance angiography codes to work with in 2001. The significant change here is that CPT has separated the head from the neck and created six codes, where before there was only one, explains Dorfman. There will be two classifications, one to address each anatomical area, and each category will have three specific MR angiography codes within it describing with, without and without followed by with contrast.

Dorfman lauds this as a significant step forward. MR angiography of the head and of the neck are truly separate procedures. If a patient has a cerebral vascular accident (CVA or stroke), for instance, you may want to conduct MR angiography of the brain and then, later, conduct a study of the neck vasculature. These are completely different studies.

The new codes are:

Head

70544 magnetic resonance angiography, head;
without contrast material(s)

70545 ... with contrast material(s)

70546 ... without contrast material(s), followed
by contrast material(s) and further sequences

Neck


70547 magnetic resonance angiography, neck;
without contrast material(s)

70548 ... with contrast material(s)

70549 ... without contrast material(s), followed
by contrast material(s) and further sequences

Computerized Tomographic Angiography Codes

According to Parman, CPT 2001 also provides CT angiography codes for each body area as well. Most coders I know are thrilled about this, she says, noting that this area has been confusing in the past. New codes are as follows:

Head 70496

Neck 70498

Chest 71275

Spine 72191

Upper extremities 73206

Lower extremities 73706

Abdomen 74175

Parman cautions that one of the new CT angiography codes does not appear under the specific body area in the CPT 2001 manual as other CT codes do. Code 75635 (computerized tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, radiological supervision and interpretation, without contrast material[s], followed by contrast material[s] and further sections, including image post-processing) appears instead in the Aorta and Arteries section.

Description of Views Change

Among the common sense changes in CPT 2001, Parman says, is the revision of how radiologic views are described. In the past, codes included a description of what type of view was covered by a particular code like AP or lateral, she explains. For 2001, CPT will replace the designation of the type of view simply with the number of views covered by the code two views or three views, for example. The change applies for codes describing radiologic views of the cervical spine, thoracic spine, lumbar spine, pelvis, elbow, forearm, wrist, femur, tibia, fibula, ankle and foot.

For studies of the spine and pelvis, for instance, the description for code 72040 will read radiologic examination, spine, cervical, two or three views instead of radiologic examination, spine, cervical; anteroposterior and lateral as in the past.

This clears up a lot of confusion because different radiology practices have different protocols, Parman says. In the past, if the dictation didnt document the same views as the code description, coders werent sure what to do. Now that question is resolved.

MRI Contrast Codes

A second common sense change can be found in the MRI codes, Parman adds. All MRI studies will be coded with the same methodology used for the CT codes. Codes have been added so MRIs will have a code for with, without and without followed by with contrast materials.

She notes, however, that these codes have not been added sequentially. Coders will notice that these codes dont follow a pattern where the first in the series is with, the next without and the third without followed by with. They have been added where code numbers were available, so they will have to be reported carefully.

Replacing G0159

According to Dorfman, CPT 2001 also features a code to replace the temporary G0159 describing all percutaneous methods of opening thrombosed dialysis shunts including mechanical thrombectomy, Fogarty balloon and administration of a thrombolytic agent. The new code is 36870 (thrombectomy, percutaneous, arteriovenous fistula, autogenous or nonautogenous graft [includes mechanical thrombus extraction and intra-graft thrombolysis]).

Parman adds, however, that coding experts are not certain at this point if Medicare will continue to require G0159 or if the carriers will instead insist on 36870.

Endovascular Codes

A significant addition to the interventional radiology codes is a series related to endovascular abdominal aortic aneurysm repair (75952-75953 and 34800-34832), according to Dorfman. This long series describes various surgical aspects of grafts and related procedures, as well as the appropriate radiological supervision and interpretation (RS&I) codes to use in each instance, he says. These codes carry precise definitions that are important for coders to understand.

The new procedural and RS&I codes are structured so that angiography performed during the procedure to place the graft, or during a procedure to expand the graft, is included. If there is a stenosis beyond the graft or an occlusion in a vessel outside of the graft, however, angiography and percutaneous therapies for these separate clinical problems may be coded separately.

Note: Although this story highlights many of the significant changes radiology coders will address in 2001, it is not a comprehensive review of all the modifications. Additional information on the codes summarized here will be provided in upcoming months, along with information about other changes not covered here.