Radiology Coding Alert

Plus: The definitions of 93922-93924 will take up a lot more space in 2011.

January is just around the corner, so there's no time like the present to start easing your practice into the CPT 2011 changes that will be in effect on the first day of the year. Get your feet wet with this comparison of the 2010 and 2011 code definitions for several diagnostic radiology codes.

Swap 76880 for 76881-76882 in 2011

You'll be deleting at least three codes from your diagnostic radiology coding options, says Cheryl A. Schad, BA Ed, CPC, ACS-RA, PCS, president and CEO of Schad Medical Management in Mullica Hill, N.J.:

• 76150 -- Xeroradiography
• 76350 -- Subtraction in conjunction with contrast studies
• 76880 -- Ultrasound, extremity, nonvascular, real time with image documentation.

You're unlikely to miss 76150 (which describes a type of X-ray in which the image is recorded on paper rather than on film) or 76350 (software now performs subtraction, so your documentation probably hasn't supported reporting 76350 for quite some time).

On the other hand, if you perform nonvascular extremity ultrasounds, you may wonder what you'll do without 76880. The answer is that you'll have two new codes appropriate for these ultrasounds,

Schad notes. The first specifies "complete," and the second is for "limited, anatomic specific":

• 76881 -- Ultrasound, extremity, nonvascular, real-time with image documentation; complete
• 76882 -- ... limited, anatomic specific.

74176-74178 Add to, Don't Replace, Existing CT Codes

You may recall that last month we listed three new-for-2011 CT codes:

• 74176 -- Computed tomography, abdomen and pelvis; without contrast material
• 74177 -- ... with contrast material(s)
• 74178 -- ... without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions.

Current reports indicate that CPT will not be deleting the current abdominal CT and pelvic CT codes, so you'll have 74176-74178 in addition to the abdominal-only and pelvic-only codes. Look to future issues of Radiology Coding Alert to bring you details on how the AMA intends you to use these codes. We'll have reports direct from the AMA's CPT and RBRVS 2011 Annual Symposium.

CPT Adds Examples to 93922-93924

If you've been longing for more details in your noninvasive physiologic code definitions, you'll get your wish in 2011. Check out how the 2010 and 2011 definitions compare for 93922-93924.

➤ 93922

When looking at the 93922 definitions, notice that the 2010 version refers to "single level," while the 2011 version offers several examples that refer to "1-2 levels":

2010: 93922 -- Noninvasive physiologic studies of upper or lower extremity arteries, single level, bilateral (e.g., ankle/brachial indices, Doppler waveform analysis, volume plethysmography, transcutaneous oxygen tension measurement)

2011: 93922 -- Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (e.g., for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional, Doppler waveform recording and analysis at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus volume plethysmography at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries with transcutaneous oxygen tension measurements at 1-2 levels).

➤ 93923

One of the changes to watch for 93923 is the switch from "multiple levels" in 2010 to "3 or more levels" in 2011:

2010: 93923 -- Noninvasive physiologic studies of upper or lower extremity arteries, multiple levels or with provocative functional maneuvers, complete bilateral study (e.g., segmental blood pressure measurements, segmental Doppler waveform analysis, segmental volume plethysmography, segmental transcutaneous oxygen tension measurements, measurements with postural provocative tests, measurements with reactive hyperemia)

2011: 93923 -- Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, 3 or more levels (e.g., for lower extremity: ankle/ brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental blood pressure measurements with bidirectional Doppler waveform recording and analysis, at 3 or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental volume plethysmography at 3 or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental transcutaneous oxygen tension measurements at 3 or more level(s), or single level study with provocative functional maneuvers (e.g., measurements with postural provocative tests, or measurements with reactive hyperemia).

➤ 93924

The change to 93924 is the addition of a lot more detail to explain what CPT intends the code to describe:

2010: 93924 -- Non-invasive physiologic studies of lower extremity arteries, at rest and following treadmill stress testing, complete bilateral study

2011: 93924 -- Noninvasive physiologic studies of lower extremity arteries, at rest and following treadmill stress testing, (i.e., bidirectional Doppler waveform or volume plethysmography recording and analysis at rest with ankle/ brachial indices immediately after and at timed intervals following performance of a standardized protocol on a motorized treadmill plus recording of time of onset of claudication or other symptoms, maximal walking time, and time to recovery) complete bilateral study.

Outpatient Centers Should Watch Cat. II Change

You also will see revisions to at least three radiology-related Physician Quality Reporting Initiative (PQRI) codes, Schad notes. The changes to 3111F and 3112F are of particular interest because the 2011 codes add a reference to performance of CT or MRI in an outpatient imaging center. The 2010 code definitions as printed in the CPT 2010 manual (there were later revisions) referred only to hospital arrival.

➤ 3110F

2010: 3110F -- Presence or absence of hemorrhage and mass lesion and acute infarction documented in final CT or MRI report (STR)

2011: 3110F -- Documentation in final CT or MRI report of presence or absence of hemorrhage and mass lesion and acute infarction (STR)

➤ 3111F

2010: 3111F -- CT or MRI of the brain performed within 24 hours of arrival to the hospital (STR)

2011: 3111F -- CT or MRI of the brain performed in the hospital within 24 hours of arrival OR performed in anoutpatient imaging center, to confirm initial diagnosis of stroke, TIA or hemorrhage (STR)

➤ 3112F

2010: 3112F -- CT or MRI of the brain performed greater than 24 hours after arrival to the hospital (STR)

2011: 3112F -- CT or MRI of the brain performed greater than 24 hours after arrival to the hospital OR performed in an outpatient imaging center for purpose other than confirmation of initial diagnosis of stroke, TIA, or hemorrhage (STR) Category II codes provide a lot of information, says Susan Vogelberger, CPC, CPC-H, CPC-I, CMBS, CCP-P, CEO of Healthcare Consulting & Coding Education. Many practices never use them, but they are very important for performance measurements, she adds.