Radiology Coding Alert

Home in on a few crucial lung biopsy and CT scan codes.

The process of making preparations for what’s to come in the upcoming edition of the CPT^® code book can be a source of anxiety, confusion, and plain exhaustion. While radiology coders are always on the lookout for new and revised codes that make their jobs easier, it’s also a relief to see that the upcoming list of changes isn’t especially extensive in your given specialty.

As for the modifications within the 2021 CPT^® code book, it’s a relatively mixed bag. The changes might seem daunting on the surface, but a deeper exploration into the fine print should ease the minds of those making preparations for a worst-case scenario.

Read on for a full breakdown of new, revised, and deleted codes to consider within the diagnostic and interventional radiology specialties.

See How Lung Biopsy Coding Changes in 2021

To begin, you should start out with this deleted, and subsequently replaced, code that applies to both diagnostic and interventional radiologists:

• 32405 (Biopsy, lung or mediastinum, percutaneous needle)
• 32408 (Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed)

You may be initially wondering why the AMA proceeded to create a brand-new code when they could have simply revised the code description of the original. Typically, when the dynamics of a particular CPT^® code change drastically enough, it warrants the creation of a new code in order to convey the magnitude of the overhaul to the coding community.

In this example, in addition to some descriptive details such as “core needle” and “percutaneous,” the underlying difference has to do with the inclusion of imaging guidance. In previous years, you’d have to report code 32405 with 77012 (Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation) when the physician utilized CT guidance. The CPT^® Editorial Panel by the Relativity Assessment Workgroup (RAW) found that these two services were performed in tandem more than 75 percent of the time in previous years. The RAW made the executive decision to simplify the process for both coders and payers processing the claims by bundling these services.

Take Note of Numerous Category I, III Code Additions

Next up, you need to take into account a set of CT scan changes involving a few new Category I and Category III codes:

• 71271 (Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s))
• 0633T (Computed tomography, breast, including 3D rendering, when performed, unilateral; without contrast material)
• 0634T (…with contrast material(s))
• 0635T (…without contrast, followed by contrast material(s))
• 0636T (Computed tomography, breast, including 3D rendering, when performed, bilateral; without contrast material(s))
• 0637T (…with contrast material(s))
• 0638T (…without contrast, followed by contrast material(s))

Right off the bat, you can see that you’ll no longer have to resort to HCPCS Level II code G0297 (Low dose CT scan (LDCT) for lung cancer screening) for LDCT reporting. Based on the heavy utilization of code G0297 in diagnostic radiology practices, the AMA followed through on CPT^® Editorial Panel recommendations to create a permanent CPT^® Category I code for this service.

Continuing on the subject of diagnostic radiology, you’ll also notice a set of unilateral and bilateral breast CT scan Category III codes that are eligible for 2021 reporting. Up until 2021, the CPT^® code book has not included any codes, Category III or otherwise, for breast CT scan reporting. You’ll now have the option to report one of two code sets, depending on laterality. Furthermore, you don’t need to worry about finding documentation to support optional 3D rendering.

Consider a Few More Important Category III Codes

Lastly, you’ll want to consider four more Category III code for reporting of intravertebral magnetic resonance spectroscopy (MRS) services:

• 0609T (Magnetic resonance spectroscopy, determination and localization of discogenic pain (cervical, thoracic, or lumbar); acquisition of single voxel data, per disc, on biomarkers (ie, lactic acid, carbohydrate, alanine, laal, propionic acid, proteoglycan, and collagen) in at least 3 discs)
• 0610T (… transmission of biomarker data for software analysis)
• 0611T (… postprocessing for algorithmic analysis of biomarker data for determination of relative chemical differences between discs)
• 0612T (… interpretation and report)

According to the American College of Radiology (ACR), “MRS is a proven and useful method for the evaluation, assessment of severity, therapeutic planning, post-therapeutic monitoring, and follow-up of diseases of the brain and other regions of the body.” When it comes to MRS utilized in examining discogenic pathology, the provider will incorporate a proprietary software called NOCISCAN™,” explains Barry Rosenberg, MD, chief of radiology at United Memorial Medical Center in Batavia, New York. According to Nocimed™, NOCISCAN™ “evaluates each vertebral disc for spectral signatures for pain biomarkers derived from degenerative pain biomarkers.”