Radiology Coding Alert

Be sure you catch the reportable codes that you won't find in your manual.

Don't let your guard down -- CPT 2009 may include only a few new codes for the radiology section, but there are several revisions and codes outside of the 70000 range you don't want to miss. Here's a breakdown of all the codes you're most likely to use and where to find them.

Remember: You should report these codes for services on or after Jan. 1.

If you automatically assign a general fine needle aspiration code to every aspiration, January brings one more reminder that when you have a specific coding option appropriate to your case, you should assign that code instead of a general one.

What's new: CPT 2009 adds a code specific to percutaneous diagnostic disc aspiration.

2008 method: For 2008 services, radiologists report this service with 10022 (Fine needle aspiration; with imaging guidance), says radiology coding expert Jackie Miller, CCS-P, CPC, vice president of product development for Coding Metrix in Powder Springs, Ga.

2009 method: For services on Jan. 1, 2009, or later, you instead should report new code 62267 (Percutaneous aspiration within the nucleus pulposus, intervertebral disc, or paravertebral tissue for diagnostic purposes), Miller says.

An explanatory note with this new code instructs you to look to 77003 (Fluoroscopic guidance and localization of needle or catheter tip ...) and 77012 (Computed tomography guidance ...) for imaging.

Potential mistake: A note with 77003 states a number of codes, including 62267, include "injection of contrast during fluoroscopic guidance and localization." This note means the listed codes include the contrast injection -- not the fluoro guidance and localization. You may report 62267 and 77003 together.

62287 change: Because you'll have 62267 for diagnostic aspiration, CPT 2009 revises discectomy code 62287 to clarify its use. In 2008, the code descriptor reads, "Aspiration or decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method, single or multiple levels, lumbar (e.g., manual or automated percutaneous discectomy, percutaneous laser discectomy)."

The 2009 version deletes "Aspiration or." It also adds a note not to report 62287 with 62267.

How it helps: The clinical example for 62287 involved therapeutic aspiration of a bulging disc for decompression -- not diagnostic aspiration -- but the code descriptor wasn't really clear about this. The 2009 change helps clear up confusion about proper 62287 use.

If you code nuclear medicine procedures, don't miss 2009 code 78808 (Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous [e.g., parathyroid adenoma]).

According to the Society of Nuclear Medicine (SNM), you'll use 78808 for the resources needed to provide intravenous radioactive drugs before gamma probe localization www.snm.org/index.cfm?PageID=8125&RPID=10).

You'll still use 38792 (Injection procedure; for  identification of sentinel node) for sentinel lymph node identification without scintigraphy imaging, according to a CPT note.

Quality measures: You won't find all the new nuclear medicine codes in the CPT 2009 manual, though. For the first time, you have nuclear medicine specific quality measure codes for the Physician Quality Reporting Initiative (PQRI). They went into effect Oct. 1, 2008, but didn't make it into the 2009 manual:

• 3570F -- Final report for bone scintigraphy study includes correlation with existing relevant imaging studies (e.g., x-ray, MRI, CT) corresponding to the same anatomical region in question (NUC_MED)

• 3572F -- Patient considered to be potentially at risk for fracture in a weight-bearing site (NUC_MED)

• 3573F -- Patient not considered to be potentially at risk for fracture in a weight-bearing site (NUC_MED).

You can find their full description at http://www.ama-assn.org/ama/pub/category/10616.html and read about participating in PQRI at http://www.cms.hhs.gov/pqri/.

If you have payers who still cover automated data generation codes 78890-78891, CPT 2009 has bad news.

The latest CPT version deletes 78890 (Generation of automated data: interactive process involving nuclear physician and/or allied health professional personnel; simple manipulations and interpretation, not to exceed 30 minutes) and 78891 (... complex manipulations and interpretation, exceeding 30 minutes).

Reason: "As technology has progressed, the components of computer processing required for nuclear medicine procedures have been included directly in the 78000 series of codes," states the SNM site.

Data manipulation used to be "an added piece when computers were first introduced as a part of routine nuclear medicine in the 1970s and early 1980s," explains Bruce W. Hammond, CRA, CNMT, executive vice president of Diagnostic Health Services, which serves more than a dozen states.

"Newer systems are largely computer-based with a corresponding reduction in analog hardware," Hammond points out.

Reality: Medicare hasn't paid these codes for some time, Hammond says, although a few other payers offer reimbursement. Overall, not being able to report these codes separately in 2009 won't be a big revenue loss, "not because the previously allowed charge amounts were added to the allowables for the study codes, but because reimbursement had all but evaporated over the past several years," Hammond says.

4. Expand Your Contrast Options for 74270

CPT 2009 makes a small but important change to 74270:

2008: Radiologic examination, colon; barium enema, with or without KUB

2009: Radiologic examination, colon; contrast (e.g., barium) enema, with or without KUB.

How this helps: Although you'll usually see barium or barium and air enemas, some physicians instead may choose a water-soluble solution that includes iodine. For example, if the physician suspects perforation of the colon, he'll choose a water-soluble contrast solution, notes Miller. By not limiting 74270 to barium, you'll know you can use this code if you see a different kind of contrast agent used and documented.

If your ultrasound techs are performing echocardiograms, don't miss the changes to coding for echo with spectral and color flow Doppler.

2008: For 2008 services, you report 93307 (Echocardiography, transthoracic, real-time with image documentation [2D] with or without M-mode recording; complete) with add-on codes for the Doppler, such as +93320 (Doppler echocardiography, pulsed wave and/or continuous wave with spectral display; complete [List separately in addition to codes for echocardiographic imaging]) and +93325 (Doppler echocardiography color flow velocity mapping [List separately in addition to codes for echocardiography]).

2009: New code 93306 (Echocardiography, transthoracic, real-time with image documentation [2D], includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography) simplifies your coding by combining the services in one code.

CPT 2009 also updates 93307 to the following: Echocardiography, transthoracic, real-time with image documentation [2D], includes M-mode recording, when performed, complete, without spectral or color  Doppler echocardiography.

And you'll find a new instructional note telling you "do not report 93307 in conjunction with 93320, 93321, 93325."