Radiology Coding Alert

New angioplasty codes include S&I and disregard open vs. percutaneous approach.

The American Medical Association (AMA) has released full descriptors and details for CPT^® changes for 2017. CPT^® 2017 has deleted the S&I codes for angioplasty procedures. However, the new codes will still allow you to report your radiologist’s services.

Bottom line: You need to analyze detailed descriptors before you can identify the best code. Here is an overview of changes you will see in 2017.

Mark These Deletions for 2017

The 2017 code set deletes the associated Supervision and Interpretation (S&I) codes for arterial and venous angioplasty:

• For peripheral artery angioplasty S&I: 75962 (Transluminal balloon angioplasty, peripheral artery other than renal, or other visceral artery, iliac or lower extremity, radiological supervision and interpretation) - +75964 (Transluminal balloon angioplasty, each additional peripheral artery other than renal or other visceral artery, iliac or lower extremity, radiological supervision and interpretation [List separately in addition to code for primary procedure])
• For renal or other visceral artery angioplasty S&I: 75966 (Transluminal balloon angioplasty, renal or other visceral artery, radiological supervision and interpretation) - +75968 (Transluminal balloon angioplasty, each additional visceral artery, radiological supervision and interpretation [List separately in addition to code for primary procedure])
• For venous angioplasty S&I: 75978 (Transluminal balloon angioplasty, venous [e.g., subclavian stenosis], radiological supervision and interpretation).

The 2017 code set also deletes the following transluminal balloon angioplasty codes:

• Codes 35450 (Transluminal balloon angioplasty, open; renal or other visceral artery) - 35460 (Transluminal balloon angioplasty, open; venous) for open procedures, and
• Codes 35471 (Transluminal balloon angioplasty, percutaneous; renal or visceral artery) - 35476 (Transluminal balloon angioplasty, percutaneous; venous) for percutaneous procedures.

List the New Angioplasty Codes

For arterial angioplasty procedures, you have the following new codes. You use the first code for the initial artery and the second for each additional artery:

• 37246, Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery
• +37247, … each additional artery (List separately in addition to code for primary procedure).

Similarly, for venous angioplasty, you have the following distinct codes for initial and additional veins:

• 37248, Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein
• +37249, … each additional vein (List separately in addition to code for primary procedure).

Understand What’s New for Angioplasty

The new codes introduce the following reforms:

One code for open and percutaneous procedures: You no longer have distinct codes for open and percutaneous angioplasty services. The new codes apply regardless of whether the service is open or percutaneous.

S&I inclusive in new codes: The new codes are inclusive of S&I services. You can hence submit the new codes and continue to earn for your radiologist’s supervision. “The new codes continue the CPT^® trend of providing one code to replace a procedure plus an S&I code,” says Ray Cathey, PA, MHS, CMSCS, CHCI, president of Medical Management Dimensions in Stockton, Calif.

Look for vessels that disqualify codes: The code descriptors list vessel services the codes do not apply to instead of listing the specific vessels the codes do apply to. This construction requires that you navigate your Index, and familiarize yourself with other code options, and thoroughly read any guidelines that apply.

You may look the new artery angioplasty codes, 37246 and +37247. The code descriptors clearly exclude ‘lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary.’ However, you have other specific codes for these arteries. You have other codes that apply to these services, such as

• Lower extremity codes 37220-+37239, and
• Coronary codes 92920-92944.

Watch the sequence: To replace the deleted codes, CPT^® 2017 adds resequenced codes. Resequenced means you won’t find the codes in the manual in numerical order, but you will find them with similarly defined codes. CPT^® identifies resequenced codes with a symbol: #.

Find 3 New Codes For Moderate Sedation

Your radiologist may perform some painful diagnostic or therapeutic procedures under moderate sedation. Now is the right time to gear up for changes in codes for reporting moderate sedation. The AMA has deleted some of the widely used moderate sedation codes. You will now have new options in 2017.

Overview of current codes: Moderate sedation codes 99143, 99144, and 99145 will be deleted effective Jan. 1, 2017. These existing codes are listed below:

• 99143 – Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; younger than 5 years of age, first 30 minutes intra-service time
• 99144 – … age 5 years or older, first 30 minutes intra-service time
• +99145 – … each additional 15 minutes intra-service time (List separately in addition to code for primary service).

Prepare for the change: In 2017, you will have 3 new codes which you can submit for moderate sedation provided by the same physician or other qualified health care professional. Your physician may use moderate sedation when performing some diagnostic or therapeutic services.

Sedation In Radiology Practices

What your radiologist does? When administering sedation, your physician offers services beyond just the administration of the pharmacological agent. Your radiologist is responsible for knowing the medical history, any medications that may increase risks with sedation, the vitals of the patient and the underlying condition necessitating the radiological investigation. Your physician will also monitor the patient during the procedure and post-procedure recovery until discharge.

Guidelines to assist patient care: The American College of Radiology (ACR) has defined practice guidelines for the use of sedation in radiology procedures. These guidelines assist in patient care. You can refer to these guidelines at: http://www.acr.org/~/media/F194CBB800AB43048B997A75938AB482.pdf.

Following are the three new codes:

• 99151 – Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient younger than 5 years of age
• 99152 – … initial 15 minutes of intraservice time, patient age 5 years or older
• 99153 – … each additional 15 minutes intraservice time (List separately in addition to code for primary service).

How are the new codes different? When you look at the existing and the new codes, you will notice that the new code descriptors are the same for codes 99151-99153, with the key update being the addition of the phrase “other than those services described by codes 00100-01999.”