Radiology Coding Alert

Plus: You’ll discover three deleted CPT^® codes in 2022.

You may be getting used to hearing about an onslaught of coding changes — from E/M coding to COVID vaccines — but will your radiology practice get hit with massive CPT^® additions, revisions, and deletions? Here’s the good news: The American Medical Association (AMA) 2022 CPT^® code set delivers several new and altered codes, but only a select number apply to radiology. We’ve broken down what you need to know into five distinct areas.

Good advice: “Every year, radiology practices need to be aware of all the new, revised, and deleted codes to be sure they are ready to implement the necessary changes,” says Kristen Taylor, CPC, CHC, CHIAP and Associate Partner of Pinnacle Enterprise Risk Consulting Services in Columbia, South Carolina. The risk of not doing so could mean claims landing in limbo, which means more headaches for you.

Learn about the new, revised, and deleted radiology codes before they go into effect on January 1, 2022 and save yourself a lot of administrative burden in the future.

1. Bone Up on Your Trabecular Bone Score Coding Skills

A trabecular bone score (TBS) is a calculation of bone texture related to the bone microarchitecture, and physicians consider this a marker to determine the risk of osteoporosis. “The main use of a TBS is, in conjunction with measures of bone density, to help better estimate fracture risk in patients who have metabolic bone problems,” says Taylor.

Heading into 2022, you’ll have four new CPT^® codes covering TBS procedures. These codes include:

• 77089 (Trabecular bone score (TBS), structural condition of the bone microarchitecture; using dual X-ray absorptiometry (DXA) or other imaging data on gray-scale variogram, calculation, with interpretation and report on fracture-risk)
• 77090 (…; technical preparation and transmission of data for analysis to be performed elsewhere)
• 77091 (…; technical calculation only)
• 77092 (…; interpretation and report on fracture-risk only by other qualified health care professional)

In other words, if the radiologist performs the complete TBS procedure, includes the score calculation, interprets the results, and determines the fracture risk for the patient, you’ll report 77089. On the other hand, you’ll code 77090 if the radiologist simply prepares the technical component and transmits the data for analysis at another facility. You’ll use 77091 to report only the technical calculation for the TBS, but you’ll use 77092 if another qualified healthcare professional (QHP) interprets the score and determines the fracture risk.

2. Check Out Two Additions for Thermal Nerve Destruction

The AMA also added codes 64628 (Thermal destruction of intraosseous basivertebral nerve, including all imaging guidance; first 2 vertebral bodies, lumbar or sacral) and +64629 (…; each additional vertebral body, lumbar or sacral (List separately in addition to code for primary procedure)) to code the thermal destruction of the intraosseous basivertebral nerve.

According to the American College of Radiologists, this new procedure aims to deliver “effective relief for patients suffering from certain types of chronic low-back pain” (URL: www.acr.org/Advocacy-and-Economics/Coding-Source/March-April-2021/CPT-2022-Anticipated-Code-Changes). Additionally, both codes have been resequenced and +64629 is an add-on code that will be used in conjunction with the primary procedure.

3. Amend Your Understanding of CPT^® Code 75573

You should never overlook revisions. Remember, even subtle descriptor changes could mean the difference between a claim sailing through the approval process and a denial. In 2022, the AMA has revised more than 90 codes, yet they have revised only one code relating to radiology for the upcoming year.

When you’re coding CT scans, you’ll want to pay special attention to 75573 (Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology in the setting of congenital heart disease (including 3D image postprocessing, assessment of left ventricular [LV] cardiac function, right ventricular [RV] structure and function and evaluation of venous vascular structures, if performed) in 2022.

What’s different: This code revision specifies the evaluation of “left ventricular [LV] cardiac function” and “right ventricular [RV] structure,” and the “function and evaluation of vascular structures,” so you can accurately document the radiologist’s procedure (emphasis added to show the revisions). The change from venous to vascular will most likely allow for better coverage for the procedure, Taylor adds

4. You Also Have Three Deletions to Note