Radiology Coding Alert

Don't miss: Look to the Web for new chest x-ray CAD codes

If you've been hoping for category I codes to report stereotactic body radiation services, CPT 2007 has your answer. Read on to get a look at these and other new codes that will affect radiology coding in 2007.

Heed Instruction 'Not to Exceed 5 Fractions'

Instead of the 2006 category III CPT codes for stereotactic body radiation therapy (0082T-0083T), you finally have new category I CPT codes:

• 77371 -- Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cerebral lesion(s) consisting of 1 session; multi-source Cobalt 60 based    
                                       
• 77372 -- ... linear accelerator based

• 77373 -- Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions 

• 77435 -- Stereotactic body radiation therapy, treatment management, per treatment course, to one or more lesions, including image guidance, entire course
not to exceed 5 fractions.

Red flag: "Codes 77373 and 77435 specifically state that the entire course is not to exceed 5 fractions when using these codes. This means that if the planned course of treatment is 15 fractions," you must not use these codes, says Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and president of the American Academy of Professional Coders National Advisory Board.

You also have some code changes for prostate procedures. You should now use 55875 (Transperineal placement of needles orcatheters into prostate for interstitial adioelement application, with or without cystoscopy) instead of 55859.

And you have a separate code for placement of devices such as fiducial markers: 55876 (Placement of interstitial device[s] for radiation therapy guidance [e.g., fiducial markers, dosimeter], prostate [via needle, any approach], single or multiple).

Check Out the Chest X-Ray CAD Changes

"Effective Jan. 1, 2007, two new CPT III codes will replace the existing code (0152T) for chest x-ray CAD," in response to provider requests, says Michael Longacre, HealthCare Market Strategies Inc. consultant in Yamhill, Ore.:

• +0174T -- Computer aided detection (CAD) (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation and report, with or without digitization of film radiographic images, chest radiograph(s), performed concurrent with primary interpretation (List separately in addition to code for primary
procedure) (Use 0174T in conjunction with 71010, 71020, 71021, 71022, 71030)

• 0175T -- Computer aided detection (CAD) (computer algorithm analysis of digital image data   for lesion detection) with further physician review for interpretation and report, with or without digitization of film radiographic images, chest radiograph(s), performed remote from primary interpretation (Do not report 0175T in conjunction  with 71010, 71020, 71021, 71022, 71030).

Key: Use 0174T with the originating chest x-ray CPT code, Longacre says. But 0175T "is a stand-alone code that is not inclusive of the chest x-ray."

So when "that chest x-ray CAD is performed at a different time, location or by another physician than the original chest x-ray," use 0175T, he says.

Good news: Dozens of payers offered reimbursement for chest x-ray CAD code 0152T in 2006. Many providers received between $10 and $27 for lung cancer detection performed on systems such as those introduced by Riverain Medical. "The values for the new codes will not change," Longacre says.

Note: Codes 0174T and 0175T take effect Jan. 1, 2007, but you won't find them in the 2007 CPT manual.

You can find them on the AMA Web site at www.ama-assn.org/ama1/pub/upload/mm/362/cat3codes.pdf.