Radiology Coding Alert

G codes continue to apply for mammography but not for aortic aneurysm screening.

Practices have adopted and implemented the 2017 changes. Are you aware of how these changes are impacting your practice in 2017? Here is a quick review of CPT® codes that are deleted, new codes that apply, and more.

Turn to 76706 for AAA

You now have a new CPT^® code for screening of abdominal aortic aneurysms. In 2017, you no longer submit the code G0389 for screening of abdominal aortic aneurysm. When your physician performs an ultrasound of the abdomen to screen for an aneurysm in the aorta, you will now submit code 76706 (Ultrasound, abdominal aorta, real time with image documentation, screening study for abdominal aortic aneurysm [AAA]).

What does the new code mean to your practice? The new code carries an RVU of 2.66. This is a step up for your reimbursement when compared to G0389 (RVU 1.66). You can now earn about $35 for screening of abdominal aortic aneurysms.

G Codes Continue To Apply For Mammography

When submitting mammography claims, you can continue to follow Medicare. This means that providers can continue to use the existing G codes for mammography. Medicare will continue to accept the following codes for mammography:

• G0202, Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed,
• G0204, Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral, and
• G0206, Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral.

CMS has introduced new codes for mammography procedures, both diagnostic and screening. The new codes are: 77065 (Diagnostic mammography, including computer-aided detection [CAD] when performed; unilateral), 77066 (Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral), and 77067 (Screening mammography, bilateral [2-view study of each breast], including computer-aided detection [CAD] when performed).

Why the new codes? CPT^® added these new codes to bundle computer-aided detection (CAD) in with unilateral or bilateral diagnostic mammography and screening mammography, X-ray imaging of the breast. “Computer-aided detection (‘CAD’) has become increasingly commonplace in most radiology centers,” says Kelly C. Loya, CPC-I, CHC, CPhT, CRMA, Managing Director of Pinnacle Enterprise Risk Consulting Services (“PERCS”), a division of Pinnacle Healthcare Consulting. “Since coding these two [CAD and mammogram] radiological images had been separate and typically performed together, the codes were combined to include CAD in the imaging service rendered when it is performed.”

It isn’t yet time to implement the new codes: CMS is not accepting the new codes in this year. There are issues in processing claims with these codes. CMS has released ‘Frequently Asked Questions for Mammography Services ‘to address common concerns for mammography services. In this document, CMS has clearly stated the inability to accept these codes in 2017. “Seems like the internal processing systems are not able to properly handle the changes,” says Michele Midkiff, CPC-I, RCC, an interventional and neuro-interventional radiology coding consultant in Mountain View, CA.

Payer preference: Most payers should have aligned to CMS directives for mammography codes. However, to avoid any confusion, you can check with your payers before you submit a claim for mammography.

Impact on practices: This is likely to impact practices in ways more than one. “It would be a massive fail if they could not process claims properly, and adversely affect practices who will not be paid properly. Also, small practices may have to close if they are not reimbursed,” Midkiff says. CMS too is bound to face challenges. “Downstream effect would include CMS does not have the staffing to support all the customer service claims calls. Nightmare in the making,” Midkiff says.

CMS speaks: According to CMS, “For reasons related to claims processing systems, CMS will be unable to properly process claims using CPT^® codes 77065, 77066, and 77067 for 2017.” You can access CMS guidance on: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Downloads/FAQ-Mammography-Services-Coding-Direct-Digital-Imaging.pdf.

Fluoroscopic Guidance Transitions to Add-on Status

In 2017, the following codes for fluoroscopy have been revised to designate these as add-on codes.

• 77002, Fluoroscopic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device) (List separately in addition to code for primary procedure) 
• 77003, Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid) (List separately in addition to code for primary procedure)

What the add-on status means for your practice: You will now report the codes 77002 and 77003 with the base procedure codes. This essentially means that the provider who is billing for the fluoroscopic guidance needs to be the same who is billing for the procedure code. Before you submit these codes, make sure you have confirmed what services your radiologist provides for the intervention procedures. “This is just moving more in the direction of bundling codes,” Midkiff says.

Editor’s note: You can view current-year codes at www.cms.gov/medicare/coding/hcpcsreleasecodesets/alpha-numeric-hcpcs.html.