Radiology Coding Alert

Brace yourself for incoming changes to diagnostic, interventional specialties.

If you are not already, you'll soon be acutely aware of the broad range of new and revised CPT^® coding changes for the beginning of the new year. You were briefed on some of the most fundamental changes to the radiology specialty in last month's issue, but there are many more codes to consider, especially if your specialty extends into the interventional side of radiology.

In this issue, the focus will shift to some new interventional radiology and category III codes, in addition to a plethora of other revisions and deletions to take note of.

Read further for all you need to know about 2018's radiological CPT^® coding changes.

Familiarize Yourself with these New Interventional Codes

For those with an interventional radiology background, you'll want to get acquainted with these two new sets of codes. The first pair (36465, 36466) is for an ultrasound-guided foam sclerosant injection into one or more extremity truncal veins. The second pair (36482, 36483) is for image-guided endovenous ablation therapy treatment for one or more incompetent veins of the extremity.

Here's the aforementioned quartet of codes:

• 36465, Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein)
• 36466, ... multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg
• 36482, Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; first vein treated
• 36483, ... subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure)

Get to Know These Category III Codes

Next up is a set of four category III codes focusing on measurements of coronary fractional flow reserve (FFR):

• 0501T, Noninvasive estimated coronary fractional flow reserve (FFR) derived from coronary computed tomography angiography data using computation fluid dynamics physiologic simulation software analysis of functional data to assess the severity of coronary artery disease; data preparation and transmission, analysis of fluid dynamics and simulated maximal coronary hyperemia, generation of estimated FFR model, with anatomical data review in comparison with estimated FFR model to reconcile discordant data, interpretation and report
• 0502T, ... data preparation and transmission
• 0503T, ... analysis of fluid dynamics and simulated maximal coronary hyperemia, and generation of estimated FFR model
• 0504T, ... anatomical data review in comparison with estimated FFR model to reconcile discordant data, interpretation and report

Additionally, you will want to take note of four new fetal magnetic cardiac signal recording category III codes:

• 0475T, Recording of fetal magnetic cardiac signal using at least 3 channels; patient recording and storage, data scanning with signal extraction, technical analysis and result, as well as supervision, review, and interpretation of report by a physician or other qualified health care professional
• 0476T, ... patient recording, data scanning, with raw electronic signal transfer of data and storage
• 0477T, ... signal extraction, technical analysis, and result
• 0478T, ... review, interpretation, report by physician or other qualified health care professional

Highlight this Important Revision to 76881,76882

Beginning in 2018, the way you code ultrasound of the extremities (limited and complete) is going to change. Previously, whether you were coding a limited or complete exam, the ultrasound examination extended to any part of the extremity at hand. However, as of January, the coding changes to 76881 and 76882 are as follows:

• 76881, Ultrasound, extremity, nonvascular, complete joint (ie, joint space and peri-articular soft tissue structures) real-time with image documentation; complete
• 76882, Ultrasound, limited, anatomic specific joint or other nonvascular extremity structure(s) (eg, joint space, peri-articular tendon[s], muscle[s], nerve[s], other soft tissue structure[s], or soft tissue mass[es]), real-time with image documentation

As you can see, the code description for these two exams has fundamentally changed; 76881 will now only pertain to complete joint spaces, and 76882 will pertain to both the joint space and/or the additional anatomical features listed above.

Careful: "When selecting 76881 for a complete examination, coders should ensure the CPT® requirements are fully met," states Amanda Corney, MBA, medical billing operations manager for Medical Resources Management in Rochester, New York. "The note must indicate that the physician is viewing both the joint space and peri-articular soft tissue structures. If the diagnostic report indicates visualization of only the joint space, or only other nonvascular structures, the coder will need to select 76882," Corney explains. Your only other option in this particular scenario is to refer back to the provider to confirm that imaging of the entire joint space, as defined by CPT®, was not performed.