Radiology Coding Alert

Watch for changes in Vertebral fracture assessment, breast imaging, vertebroplasty procedures.  

The CPT® radiology coding changes for 2015 are available now. These changes become effective January 1, 2015. Here are highlights of what changes you need to introduce in your practice next year. Prepare in advance and safeguard your reimbursements.

Check Bone Density Study with Vertebral Fracture Assessment

Currently, you bank upon 77082 (Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; vertebral fracture assessment) for vertebral fracture assessment. Effective 2015, this code will no longer be valid. You have two new codes for vertebral fracture assessment. These include 77085 (Dual-energy X-ray absorptiometry [DXA], bone density study, 1 or more sites; axial skeleton [e.g., hips, pelvis, spine], including vertebral fracture assessment) where vertebral fracture assessment is done as part of bone density study and 77086 (Vertebral fracture assessment via dual-energy X-ray absorptiometry [DXA]) which is for vertebral fracture assessment alone. “This is in keeping with the trend to clarify and increase specificity in coding,” says Michele Midkiff, CPC-I, PCS, RCC, an interventional and neuro-interventional radiology coding consultant in Mountain View, CA.

Include New Codes for Breast Ultrasound and Digital Tomosynthesis

Make note of two new codes for breast ultrasound. These include the following:

• 76641, Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete
  
• 76642,  Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; limited
  

Also add the following three codes for breast tomosynthesis to your list:

• 77061,  Digital breast tomosynthesis; unilateral
  
• 77062,  Digital breast tomosynthesis; bilateral
  
• 77063,  Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure)
  

These codes help to ensure your payment for use of new imaging technologies. “New codes continue to be developed to keep up with new technologies,” Midkiff says.

Avoid Confusion in Myelography Codes

You will spot new myelography codes in 2015 which include the supervision and interpretation. They are:

• 62302,  Myelography via lumbar injection, including radiological supervision and interpretation; cervical
  
• 62303,  Myelography via lumbar injection, including radiological supervision and interpretation; thoracic
  
• 62304, Myelography via lumbar injection, including radiological supervision and interpretation; lumbosacral
  
• 62305,  Myelography via lumbar injection, including radiological supervision and interpretation; 2 or more regions (e.g., lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical)
  

Catch the paradox: The codes 62284 and 62304 seem to represent the injection portion of the procedure. You may find it challenging to decide which of these is the most appropriate code. In this case, it will be best for you to confirm with your payer.

Revision: Note that the existing code for myelogram injection, 62284 (Injection procedure for myelography and/or computed tomography, spinal [other than C1-C2 and posterior fossa]) has been revised. The revision is as follows:

• 62284, Injection procedure for myelography and/or computed tomography, spinal lumbar (other than C1-C2 and posterior fossa)

Look for New Options for Vertebroplasty/Kyphoplasty

If you’re regularly reporting vertebroplasty and kyphoplasty procedures, then you should take note of CPT® 2015’s dramatic changes. The existing codes have been deleted, and now you’ll find new codes — specifying imaging guidance.

What happens: Both percutaneous vertebroplasty and kyphoplasty involve percutaneous injection of methylmethacrylate under imaging guidance (either fluoroscopy or CT) into a cervical, thoracic, or lumbar vertebral body lesion. Kyphoplasty also involves placement of a balloon catheter to reduce the fracture and then inject biomaterial into the cavity.

The new codes are:

• 22510 — Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic
  
• 22511— … lumbosacral
  
• 22512 — … each additional cervicothoracic or lumbosacral vertebral body (List separately in addition to code for primary procedure)
  
• 22513 — Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic
  
• 22514 — … lumbar
  
• 22515 — … each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure) 
  

“It’s important to see that the new vertebroplasty code, 22510, also includes the cervical spine region,” says Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, of MJH Consulting in Denver, Co. “If a provider performs a cervical vertebroplasty in 2014, you can only report it with 22899 (Unlisted procedure, spine). It will be good that pain management providers will be able to report the cervical procedure with the new 22510 code.” 

Each of the codes also includes the “bulls-eye” symbol designation, which means the associated RVUs and service include moderate sedation. This is new for kyphoplasty in 2015. The 2014 codes (22523-22525) did not include moderate sedation, so you could bill it separately.

The deleted codes are:

• 22520 — Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection; thoracic
  
• 22521 — … lumbar
  
• 22522 — … each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure)
  
• 22523 — Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, 1 vertebral body, unilateral or bilateral cannulation (eg, kyphoplasty); thoracic
  
• 22524 — … lumbar
  
• 22525 — … each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure)
  

Heads up: Because of the updated descriptors, the associated radiology codes for guidance will be deleted. You’ll no longer be able to report the following codes as part of your vertebroplasty or kyphoplasty claim: 

• 72291 – Radiological supervision and interpretation, percutaneous vertebroplasty, vertebral augmentation, or sacral augmentation (sacroplasty), including cavity creation, per vertebral body or sacrum; under fluoroscopic guidance 
  
• 72292 – … under CT guidance. 
  

Exception: You do not see a specific code for sacroplasty. 

If your physician does a sacral vertebroplasty then you will have two Category III codes to report that includes imaging guidance:

• 0200T — Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or mechanical device, when used, 1 or more needles, includes imaging guidance and bone biopsy, when performed
• 0201T — Percutaneous sacral augmentation (sacroplasty), bilateral injections, including the use of a balloon or mechanical device, when used, 2 or more needles, includes imaging guidance and bone biopsy, when performed.

Also: Look for the inclusive imaging guidance in these codes. “Another trend in coding is bundling the imaging guidance, reducing component coding, and potentially RVUs,” says Midkiff.

Editor’s note: Stay tuned for more CPT® 2015 information in upcoming issues of the Radiology Coding Alert.