Radiology Coding Alert

Diagnostic and screening mammography get new codes; imaging guidance may apply to interlaminar spinal injections.

With the New Year fast approaching, it is time to explore coding updates like the radiological guidance for spinal injections and devices. Here’s what lies in store for radiology coders in 2017.

Do Not Forget Imaging Guidance in Spinal Interlaminar Injections

For interlaminar injections of diagnostic or therapeutic substances, you will choose from the following two codes depending upon the region of the spine where the physician gives injection:

• 62321, Injection(s), of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (i.e., fluoroscopy or CT)
• 62323, …lumbar or sacral (caudal); with imaging guidance (i.e., fluoroscopy or CT).

When your physician administers the interlaminar diagnostic or therapeutic substance by continuous infusion or intermittent bolus, you will turn to the following codes:

• 62325, Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (i.e., fluoroscopy or CT)
• 62327,…with imaging guidance (i.e., fluoroscopy or CT).

Tip: The key principle that guides your coding for imaging guidance for interlaminar injection is the anatomical localisation of the injection in the spine.

“These codes maintain the CPT^® hierarchy of combining cervicothoracic procedures, which risk spinal cord injury, with lumbosacral injections. These codes typically are inclusive of use of image guidance, which was separately reportable under prior coding rules,” says Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison.  “The interlaminar injections allow performance without image guidance, in contrast to transforaminal injections which require image-guidance.”

Example: You may read that your administered an epidural spine injection in the lumbar region in a patient with pain after spinal surgery. You may read that your physician located the paramedian plane in the space between the laminae of the two vertebrae and advanced the needle with fluoroscopic guidance until there was “loss of resistance.” This implies that your physician entered the dorsal epidural space to administer the injection. You submit code 62323 for this procedure.

Prepare to Specify Location for Percutaneous Cryoablation of Nerves

CPT^® 2017 will introduce new Category III codes for percutaneous cryoablation of peripheral nerves. You will select the relevant code by looking at the anatomical location of the cryoablation.

For nerves in the upper and lower extremities, you will submit codes 0440T (Ablation, percutaneous, cryoablation, includes imaging guidance; upper extremity distal/peripheral nerve) and 0441T (Ablation, percutaneous, cryoablation, includes imaging guidance; lower extremity distal/peripheral nerve), respectively.

For percutaneous cyroablation of a plexus or nerves in the trunk, you will submit code 0442T (Ablation, percutaneous, cryoablation, includes imaging guidance; nerve plexus or other truncal nerve [e.g., brachial plexus, pudendal nerve]).

Spot These New Codes for Spinal Device Procedures

CPT^® 2017 will bring new codes for intervertebral, interspinous and interlaminar biomechanical and stabilization spinal devices. These new codes are listed in table 1.

What this means for you: Every time your physician uses radiological assistance to stabilise the lumbar spine, you can keep a count of levels over which the procedure is done and submit individual codes.

Diagnosis vs. Screening Intent Guides Mammography Coding

CPT^® 2017 adds specific codes for diagnostic and screening mammography. Depending upon unilateral or bilateral investigation, you will submit codes 77065 (Diagnostic mammography, including computer-aided detection [CAD] when performed; unilateral) and 77066 (…….bilateral) for diagnostic mammography. For screening mammography, you will submit code 77067 (Screening mammography, bilateral [2-view study of each breast], including computer-aided detection [CAD] when performed).

Strike off these mammography codes: The following mammography codes have been deleted.

77051, Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further review for interpretation, with or without digitization of film radiographic images; diagnostic mammography (List separately in addition to code for primary procedure)
77052, Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further review for interpretation, with or without digitization of film radiographic images; screening mammography (List separately in addition to code for primary procedure)
77055,             Mammography; unilateral
77056, Mammography; bilateral
77057, Screening mammography, bilateral (2-view study of each breast)

For more on the changes anticipated in 2017, check https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices-Items/CMS-1654-P.html.