Radiology Coding Alert

You’ll also need to update interventional radiology and RSA codes.

You will soon face challenges if you do not revise your coding for arthrocentesis, intravascular stenting, bone and lung tumor ablation therapy, and radiostereometric analysis.  To avoid denials, start learning these new changes before these changes go into effect January 1, 2015. 

Specify Whether Joint Aspiration Included U/S Guidance

In 2015, you will find new codes for joint aspiration and/or injection which include ultrasound guidance.  In addition, the existing codes will be revised to state “without ultrasound guidance.”  You’ll choose new and revised codes for arthrocentesis depending upon whether or not your physician used ultrasound guidance. “New codes were added for 2015 that are all inclusive codes when ultrasound guidance is used,” says Christy Hembree, CPC, team leader at Summit Radiology Services in Cartersville, GA.

The new and revised codes (with changes reflected) are the following:

• 20600 — Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); small joint or bursa (eg, fingers, toes)without ultrasound guidance
• (new) 20604 — … with ultrasound guidance, with permanent recording and reporting
• 20605 — Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa)without ultrasound guidance 
• (new) 20606 — … with ultrasound guidance, with permanent recording and reporting
• 20610 — Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa)without ultrasound guidance
• (new) 20611 — … with ultrasound guidance, with permanent recording and reporting

Note: These six codes will represent the services based on the number of vertebral bodies your physician treated and the spinal area. Each code will continue to represent both unilateral and bilateral injections.

What happens: Arthrocentesis, also known as joint aspiration, is the clinical procedure in which the fluid from within the joint is removed using a needle and syringe. The skin over the aspiration site is cleaned with an antiseptic liquid. The physician then pushes a needle through the skin and into the joint and then removes the fluid with the help of a syringe attached to the needle. After the aspiration, the fluid sample may be sent to the laboratory for further examination.

Watch out: Sometimes you’ll see your physician performing these procedures with fluoroscopic guidance, which the new codes do not address. “This section of changes can get a little confusing because according to the ACR  when fluoroscopic-guided arthrocentesis  is performed ‘component coding’ should still be used,” Hembree says. “This means guidance is a huge factor in coding these procedures and coders need to be careful to not forget to code fluoro separately when it is used instead of ultrasound guidance.”

Renew Intravascular Stent Coding

CPT® 2015 revises 37215-37217 (Transcatheter placement of intravascular stent[s] …) to clean up some wording and clarify that the procedures include angioplasty, when performed, and also include radiological supervision and interpretation. “The changes made to 37215 and 37216 make them more consistent with all other endovascular bundled coding,” Hembree says. 

The changes read as follows (see underlined):

• 37215, Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; with distal embolic protection
  
• 37216, Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; without distal embolic protection
  

Another change in 2015: Also note that next year you will use these codes for open or percutaneous approach. “These codes now include angioplasty and supervision and interpretation and can now be used for open or percutaneous procedures,” Hembree says.

Look for a new code: Along with those revisions, you’ll also have a new CPT® code for placement of intrathoracic common carotid or innominate artery stent.  This code includes angioplasty and imaging. In 2015, you will report 37218 (Transcatheter placement of intravascular stent[s], intrathoracic common carotid artery or innominate artery, open or percutaneous antegrade approach, including angioplasty, when performed, and radiological supervision and interpretation) for intrathoracic common carotid or innominate artery stenting. “As outlined in the 2015 CPT® book, code 36218 is to be used in conjunction with 36216, 36217, 36225, and 36226,” Hembree says. “For angiography, the book directs you to code 36222-36228, 75600-75774, and 75791. For angioplasty, the book directs you to 35472 and 35475.”

Remember: Do not report 36218 for cranial or cerebral vessels. “The ACR states that 36218 or 75774 should NOT be reported as part of diagnostic angiography of the extracranial and intracranial cervicocerebral vessels,” Hembree says. “They then go on to say that it may be appropriate to code 36218 and 75774 for diagnostic angiography of upper extremities and other vascular beds of the neck and/or shoulder girdle performed in the same session as vertebral angiography.”

Update Your Ablation Therapy Coding

Ablation therapy for bone tumors: Prepare your coding for radiofrequency bone ablation to include adjacent soft tissue and radiologic guidance in the next year.  “The bone ablation codes have been updated to include adjacent soft tissue and radiologic guidance. This should simplify the coding process and eliminates a lot of combination coding,” Hembree says.

The changes in code descriptor for 20982 are marked below.

• 20982, Ablation therapy for reduction or eradication of 1 or more bone tumor(s) tumors (e.g., metastasis),radiofrequency including adjacent soft tissue when involved by tumor extension, percutaneous,including imaging guidance when performed; radiofrequency

In addition, you will have a new code that has been added for cryoablation of bone tumors. The new code is 20983 (Ablation therapy for reduction or eradication of 1 or more bone tumors [e.g., metastasis] including adjacent soft tissue when involved by tumor extension, percutaneous, including imaging guidance when performed; cryoablation).

What does this mean for you: “Currently, you are reporting cryoablation using an unlisted code,” Hembree says. “In 2015, coders will be able to use 20983 to accurately report cryoablation of bone tumors. As we all know unlisted codes can be very difficult to receive payment for so the addition of the new codes in 2015 should improve reimbursement.”

Ablation therapy for pulmonary tumors: In 2015, you have a new category III code for cryoablation of pulmonary tumors. Add code 0340T (Ablation, pulmonary tumor[s], including pleura or chest wall when involved by tumor extension, percutaneous, cryoablation, unilateral, includes imaging guidance) to your list of ablation therapy codes in 2015. “CPT® 0340T was a created Category III code approved at the February and May 2013 CPT® Editorial Panel meetings for implementation in January 2014. However, it is new in the CPT® codebook for 2015,” Hembree says. 

 Replenish Your Practice with New RSA Codes

What is Radiostereometric analysis? Radiostereometric Analysis (RSA) is method for measuring micromotions in the skeleton with high precision using small spherical markers made of tantalum. Your physician may insert the markers in the patient’s body either surgically or non-surgically by using an insertion device. Then your physician obtains simultaneous X-rays from two angles. Finally, your physician measures the marker projections on the film and constructs three-dimensional coordinates. The motion between different segments is calculated by comparing with results from previous RSA.

List 3 new codes: In 2015, you will have three new category III codes for RSA. “Category III codes are temporary codes used to report emerging technology, services, and procedures,” Hembree says. 

Depending upon whether your physician does RSA in the spine, upper or lower limb, you select from the following codes; 

• 0348T, Radiologic examination, radiostereometric analysis (RSA); spine, (includes cervical, thoracic and lumbosacral, when performed)
  
• 0349T, Radiologic examination, radiostereometric analysis (RSA); upper extremity(ies), (includes shoulder, elbow, and wrist, when performed)
  
• 0350T, Radiologic examination, radiostereometric analysis (RSA); lower extremity(ies), (includes hip, proximal femur, knee, and ankle, when performed)
  

Adopt these new codes in your practice after checking with your payer. “These codes may or may not be covered by some or all payers,” Hembree says. “When a Category III codes best describes the services provided it must be used regardless of coverage.”

Editor’s note: Stay tuned to future issues of the Radiology Coding Alert for more information.