Radiology Coding Alert
Digitized, Screening-Mammogram Code Tops Changes for 2002
The modifications will take effect Jan. 1, 2002, for Medicare, although it may take longer for other carriers to adopt them. Radiology practices and coders should work closely with other payers to determine when to begin reporting the new codes.
Digital Mammography
CPT 2002 will contain a new code to describe digitization of screening mammography films, Dorfman says. The new code, 76085 (digitization of film radiographic images with computer analysis for lesion detection and further physician review for interpretation, screening mammography [list separately in addition to code for primary procedure]), is considered an add-on code and would always be reported with 76092 (screening mammography, bilateral [two view film study of each breast]). It would not be reported with diagnostic mammography studies.
"This new code describes computer-aided detection (CAD) services radiologists might use after conducting a screening mammogram," he says. "Digitization can help the physician better identify abnormalities for further investigation." During digitization, the radiologist loads the mammography films into a CAD processor, which digitizes and analyzes the standard images. The radiologist compares the original screening films with the digitized version and uses both to report relevant findings.
Radiofrequency Ablation of Liver Tumors
CPT 2002 will also contain a long-awaited code to describe percutaneous radiofrequency ablation of liver tumors, Dorfman explains. CPT 47382 (ablation, one or more liver tumor[s]; percutaneous, radiofrequency) will describe the procedure where the physician guides an RF needle electrode to a tumor within the liver and destroys the lesion percutaneously, as opposed to providing this service through an open wound.
In addition to the procedure, the physician would use one of three types of guidance also described by new codes in 2002 ultrasound (76490, ultrasound guidance for, and monitoring of, tissue ablation), CT (76362, computerized axial tomographic guidance for, and monitoring of, tissue ablation) or MR (76394, magnetic resonance guidance for, and monitoring of, tissue ablation). In each case, these modalities may be used to determine the appropriate approach to the lesion, to position the RF needle electrode within the tumor and, following the procedure, to confirm the effectiveness of the treatment. "Each code, however, will be reported only once per procedure," Dorfman says.
In addition to percutaneous RF ablation of liver tumors, the ultrasound (US) code, 76490, may be assigned to report similar surgical procedures through an open wound, i.e., new codes 47370-47381. Such services are usually provided during the same session as another operative intervention, Dorfman notes. "In both the percutaneous and open procedures, the procedural code should be reported by the physician who provides the procedural service, and the guidance code would be used by the physician who provides the guidance service. In some cases, both the procedure and the guidance might be provided by the same individual, in which case that physician would report both services."
Fine-Needle Aspiration
Codes that used to describe fine-needle aspiration (FNA), which included slide preparation, have been renumbered and moved from the pathology and laboratory section of CPT to the surgery section, Dorfman explains. Prior to Jan. 1, 2002, these procedures are reported with 88170 (fine needle aspiration; superficial tissue [e.g., thyroid, breast, prostate]) and 88171 ( deep tissue under radiologic guidance). "Because the aspiration biopsy and the slide preparation were most often performed separately and by different physicians, some payers were denying legitimate procedural claims," he says.
The new FNA codes are 10021 (fine needle aspiration; without imaging guidance) and 10022 ( with imaging guidance). The latter code carries a cross reference to radiology supervision and interpretation (RS&I) codes 76003 (fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]), 76360 (computerized axial tomographic guidance for needle biopsy, radiological supervision and interpretation) and 76942 (ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation). The new codes describe needle aspirations in which a core of tissue is not obtained, Dorfman says. "When a core biopsy is performed with a needle, without regard to needle size, the appropriate core-biopsy code should be reported, when such a specific code exists," he says.
Arthrography Instructions
According to Dorfman, CPT 2002 also contains specific instructions about when and when not to report fluoroscopic guidance (76003) with specific arthrography injection codes and their related imaging procedures. "In virtually all cases, fluoroscopy should not be reported in addition to these codes because it is considered a component of the specific RS&I service," he says. For example, when radiologic arthrography of the shoulder is performed, only 23350 (injection procedure for shoulder arthrography) and 73040 (radiologic examination, shoulder, arthrography, radiological supervision and interpretation) would be reported without any additional fluoroscopy code, even if fluoroscopy were used for guidance.
These instructions do not apply when fluoroscopic guidance is used with arthrography procedures involving imaging performed under CT or US (e.g., 73201, computerized axial tomography, upper extremity; with contrast material[s]), and MR arthrography (73222, magnetic resonance [e.g., proton] imaging, any joint of upper extremity; with contrast material[s]). In these instances, 76003 may be reported separately.
Radiation Oncology
Two new codes have also been introduced to the radiation oncology section of CPT. Code 77301 (intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications) describes the treatment plan for intensity modulated radiation treatment (IMRT), including calculations affecting delivery of radiation to the tumor and surrounding normal tissues. Likewise, 77418 (intensity modulated treatment delivery, single or multiple fields/arcs, via narrow spatially and temporally modulated beams [e.g., binary, dynamic MLC], per treatment session) is for the delivery of radiation therapy. The planning code, 77301, should be reported only once per course of therapy to a specific treatment area. However, an additional plan may be reported if clinical indications require a change to the treatment plan. Code 77418 should be reported only once per treatment session.
Other new codes of interest to radiation oncology practices include:
Language Changes
In addition to the new codes and clarifications, CPT 2002 contains numerous verbiage changes intended to clarify the use of specific codes. For instance, "ultrasound" replaces the more dated "echography" in a number of code definitions to better reflect current clinical terminology.
Several codes were also updated to better reflect current practice. 76066 is now defined as joint survey, single view, two or more joints (specify), whereas the previous definition references "one joint." This change was made because it is difficult to survey only one joint. Likewise, 76819 now reads fetal biophysical profile; without non-stress testing. Reference to "stress" testing was removed because stress tests are never performed during fetal biophysical profiles.
More information regarding these and other CPT 2002 code changes will be provided to subscribers of Radiology Coding Alert following the CPT Symposium in November.
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