Radiology Coding Alert

Radiology coders must pay close attention to language changes in the front matter of CPT 2002, according to Michael Beebe of the AMA. He notes that the modification represents a "subtle but major change" in how radiologists and coders report services that are not precisely described by an existing code. Beebe provided this information during the AMA's CPT 2002 Coding Symposium in Chicago, Nov. 15 and 16, 2001.
 
Instructions about coding these services may be found in the introduction section of the CPT 2002 manual (page x), under the heading "Instructions for Use of CPT." The new directions read (revisions appear in italics):
 
"Select the name of the procedure or service that accurately identifies the service performed. Do not select a CPT Code that merely approximates the service provided. If no such procedure or service exists, then report the service using the appropriate unlisted procedure or service code. In surgery, it may be an operation; in medicine, a diagnostic or therapeutic procedure; in radiology, a radiograph. Other additional procedures performed or pertinent special services are also listed. When necessary, any modifying or extenuating circumstances are added. Any service or procedure should be adequately documented in the medical record.
 
"It is important to recognize that the listing of a service or procedure and its code number in a specific section of this book does not restrict its use to a specific specialty group. Any procedure or service in any section of this book may be used to designate the services rendered by any qualified physician or other qualified health care professional."

Emphasis on Unlisted-Procedure, Category III Codes

In the past, these directions simply noted that coders should "select the name of the procedure or service that most accurately identifies the service performed," and gave no further instructions to use unlisted-procedure codes. Beebe notes that this change to the introductory material is important and the AMA's primary objective in making the change is to help prevent miscoding of new services. To accommodate this shift in policy, additional unlisted-procedure codes have been added to various sections and subsections of CPT , and more are anticipated.
 
The following report illustrates when an unlisted service is the most appropriate code to report:
 
A percutaneous cholangiogram with insertion of  ring biliary drainage catheter was performed on July 26. On Aug. 2 the following report was dictated:
 
Removal of ring biliary drainage catheter and  insertion of two gianturco coils. The ring biliary drainage catheter was still in place in the right upper quadrant of the abdomen. The guide wire was placed through the catheter and the catheter withdrawn. A non-side hole C2 catheter was then placed such that the distal tip was in the tract within the liver where the catheter had been placed. Two 3-mm- x 4-cm-long coils were placed in the intrahepatic tract in hopes of promoting clotting so the bile would not drain into the peritoneal cavity. The patient tolerated the procedure well.

Because no code exists to describe this service, it would be reported with 47999 (unlisted procedure, biliary tract), along with the appropriate imaging code (e.g., 76000, fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]).
 
In addition, CPT 2002 has added 22 Category III codes, developed to track the use of new and emerging technologies and services. (Codes now in place are considered Category I codes.) Placed in the CPT manual between the Medicine section and Appendix A, the temporary Category III codes are alphanumeric (e.g., 0001T, endovascular repair of infrarenal abdominal aortic aneurysm or dissection; modular bifurcated prosthesis [two docking limbs]) and their use is optional, Beebe says.  

However, CPT 2002 instructions indicate that, if available, a Category III should be reported instead of an unlisted-procedure Category I code. No relative value units (RVUs) have been attached to Category III codes.
 
Besides affecting new procedures, this new introductory language may affect coding established services. For instance, a CT scan of the temporomandibular (TMJ) joints is not accurately described by either the CT head series of codes (70450-70470) or the CT orbit, sella, posterior fossa or outer, middle, or inner ear series of codes (70480-70482). Until 2002, most practices used one of these two series of codes to describe TMJ CT exams in some cases adding modifier -52 (reduced services) to the code reported. The new introductory language in the 2002 CPT manual seems to prohibit the use of any of these codes since none of them exactly describes TMJ CT. Because no unlisted CT scan code exists, coders should use the unlisted diagnostic radiology procedure code, 76499.
 
The new language in the introduction also makes clear that services listed as, or assumed to be, physician services may also be reported when provided by other qualified healthcare professionals (e.g., advance practice nurses, physician assistants, etc.) when appropriate based on their state scope of practice.