Radiology Coding Alert

The focus shifts back to fundamental code description changes.

Now that you’ve had some time to process the plethora of CPT^® changes covered in the article Brace Yourself for Massive Radiology Changes to CPT^® 2020, you’ve got to get right back on the saddle and see what else is coming your way in the 2020 calendar year (CY).

In addition to some more important revisions and deletions to your 74XXX series gastrointestinal (GI) radiography code set, you’ll encounter a wealth of nuclear medicine changes involving myocardial imaging by positron emission tomography (PET) exams, radiopharmaceutical localization of tumor procedures, and single-photon emission computed tomography (SPECT) studies.

Read further to fill in all the remaining pieces of the CPT^® 2020 puzzle.

See What’s New With GI Imaging

To start, check out the code description changes in store for 74250:

• 74250 (Radiologic examination, small intestine, includes including multiple serial images and scout abdominal radiograph(s), when performed; single-contrast (eg, barium) study).

Similar to the previous set of revised radiologic examination of the GI codes, 74250 now spells out exactly what’s included in the service so you don’t have to play any sort of guessing game. Specifically, it explains that it’s a single-contrast study that includes any and all abdominal scout imaging.

“The new code description now reflects that any scout KUB is bundled with the exam,” explains Stacie L. Buck, RHIA, CCS-P, RCC, RCCIR, CIRCC, AAPC Fellow, president & senior consultant at RadRx. “It has always been bundled, but now it just happens to be reflected in the code description,” details Buck.

Furthermore, you’ll now be able to easily distinguish between 74250 and the revised code description of 74251:

• 74251 (…dovuble-contrast (eg, high-density barium and air via enteroclysis tube) study, including glucagon, when administered).

74251 now includes all of 74250’s code description prior to the semicolon, changing its status from a standalone code to an indented code. It distinguishes itself from 74250 by outlining its use of double contrast and glucagon, when administered.

You’ll see CPT^® make a similar change to the 74270 and 74280 code sets, respectively:

• 74270 (Radiologic examination, colon, including scout abdominal radiograph(s) and delayed image(s), when performed; single-contrast (eg, barium) enema, with or without KUB study).
• 74280 (…air double-contrast with specific (eg, high density barium and air) study, with or without glucagon including glucagon, when administered).

While the fundamentals of these codes remain intact, CPT^® further elaborates on what’s included in these services by providing additional detail prior to the semicolon. Specifically, CPT^® replaces the phrasing within 74270 from “with and without KUB” to “including scout abdominal radiograph(s) and delayed image(s), when performed.” These services were already included in 74270, but the 2020 revisions remove any room for interpretation. In addition, 74280 now contains the entire 74270 code description prior to the semicolon, removing any questions of whether it also includes the aforementioned imaging services.

Finally, with respect to radiographic imaging of the GI tract, you’ll want to make note that CPT^® will be deleting the following code from the 2020 manual:

• 74260 (Duodenography, hypotonic).

Keep the Ball Rolling With New and Revised Nuclear Medicine Codes

Next up, CPT^® further pushes to streamline and elaborate on an important set of nuclear medicine services — PET scans. More specifically, 2020 will include a huge range of new and revised codes for myocardial imaging PET scans. Begin by examining this code description revision for 78459:

• 78459 (Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), single study).

Instead of leaving any room for interpretation, CPT^® adds further detail to identify specific included components in addition to outlining that you should report 78459 as a single study. While CPT^® could have stopped there, it goes one step further by including a new code to report when the provider performs myocardial imaging PET scans with concurrently acquired computed tomography transmission (CTT) scans:

• 78429 (with concurrently acquired computed tomography transmission scan).

Instead of reporting each respective service separately, you’ll now bundle these services into the appropriate new code.

Finish Strong With Radiopharmaceutical Localization Codes and More

Continuing on with the theme of practicality and detail, CPT^® adds some much-needed context to a set of radiopharmaceutical localization of tumor codes. See what changes have been made to the standalone code 78800:

• 78800 (Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); limited planar, single area (eg, head, neck, chest, pelvis), single day imaging).

Instead of leaving you to your own devices to determine what’s all included in a nuanced service such as this one, CPT^® adds some important bits of information to the code descriptor. First, you no longer have to know that the term “limited” actually means single area. CPT^® spells it out clearly for you this time with some examples of the most commonly performed areas. What’s more, you now know that 78800 is reserved for single-day imaging, with respective revisions to the following indented codes outlining two or more areas, whole body, and single day versus two or more days imaging:

• 78801 (…multiple planar, 2 or more areas (eg, abdomen and pelvis, head and chest), 1 or more days imaging or single area imaging over 2 or more days)
• 78802 (…planar, whole body, single day imaging)
• 78804 (…planar, whole body, requiring 2 or more days imaging).

If those revisions aren’t enough to consider, you’ve got to take one final set of 78800-indented code additions into account for the 2020 CY. First, have a look at the following two deletions:

• 78806 (…whole body)
• 78807 (…tomographic (SPECT)).

Specifically, in place of 78807, you’ll find three new codes that include all the components of 78800-78804, in addition to SPECT:

• 78830 (tomographic (SPECT) with concurrently acquired computed tomography (CT) transmission scan for anatomical review, localization and determination/detection of pathology, single area (eg, head, neck, chest, pelvis), single day imaging)
• 78831 (tomographic (SPECT), minimum 2 areas (eg, pelvis and knees, abdomen and pelvis), single day imaging, or single area imaging over 2 or more days)

78832 (tomographic (SPECT) with concurrently acquired computed tomography (CT) transmission scan for anatomical review, localization and determination/detection of pathology, minimum 2 areas (eg, pelvis and knees, abdomen and pelvis), single day imaging, or single area imaging over 2 or more days).